Provider Demographics
NPI:1316054778
Name:HOME THERAPY SPECIALISTS INC
Entity type:Organization
Organization Name:HOME THERAPY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ROCHELEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:904-806-8424
Mailing Address - Street 1:341 CHICASAW CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4329
Mailing Address - Country:US
Mailing Address - Phone:904-806-8424
Mailing Address - Fax:904-429-7378
Practice Address - Street 1:341 CHICASAW CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4329
Practice Address - Country:US
Practice Address - Phone:904-806-8424
Practice Address - Fax:904-429-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19568261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9259Medicare ID - Type Unspecified