Provider Demographics
NPI:1285450726
Name:BOCA DEVELOPMENTAL THERAPY CENTER, LLC
Entity type:Organization
Organization Name:BOCA DEVELOPMENTAL THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:312-493-4641
Mailing Address - Street 1:9293 GLADES RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3905
Mailing Address - Country:US
Mailing Address - Phone:561-367-3606
Mailing Address - Fax:
Practice Address - Street 1:9293 GLADES RD STE C
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3905
Practice Address - Country:US
Practice Address - Phone:561-367-3606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1285153429OtherRACHEL KHALIFA