1033501341 NPI number — FLORIDA INTERACTIVE THERAPY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033501341 NPI number — FLORIDA INTERACTIVE THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA INTERACTIVE THERAPY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033501341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MIRANDA LN
Provider Second Line Business Mailing Address:
STE 131
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-0769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 MIRANDA LN
Provider Second Line Business Practice Location Address:
STE 131
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-0769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-780-0922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BATISTA
Authorized Official First Name:
YASHIRA
Authorized Official Middle Name:
MARYL
Authorized Official Title or Position:
TITLE MANAGER
Authorized Official Telephone Number:
407-780-0922

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA13529 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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