Provider Demographics
NPI:1194770081
Name:SPECTRUM THERAPY SERVICES
Entity type:Organization
Organization Name:SPECTRUM THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-499-1125
Mailing Address - Street 1:11011 SHERIDAN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1505
Mailing Address - Country:US
Mailing Address - Phone:954-499-1125
Mailing Address - Fax:954-499-1123
Practice Address - Street 1:11011 SHERIDAN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-1505
Practice Address - Country:US
Practice Address - Phone:954-499-1125
Practice Address - Fax:954-499-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11987225X00000X
FLOT 9969225X00000X
FLOT 9973225X00000X
FLOT11299225XP0200X
FLSA 8125235Z00000X
FLSA 7231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889816200Medicaid