Provider Demographics
NPI:1194097501
Name:TREAURE COAST THERAPISTS LLC
Entity type:Organization
Organization Name:TREAURE COAST THERAPISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-216-4339
Mailing Address - Street 1:420 SOPWITH DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9115
Mailing Address - Country:US
Mailing Address - Phone:772-216-4339
Mailing Address - Fax:
Practice Address - Street 1:420 SOPWITH DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-9115
Practice Address - Country:US
Practice Address - Phone:772-216-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty