Provider Demographics
NPI:1316227044
Name:DEVELOPMENTAL DELAY THERAPY
Entity type:Organization
Organization Name:DEVELOPMENTAL DELAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-484-0627
Mailing Address - Street 1:45 NW 8TH ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4452
Mailing Address - Country:US
Mailing Address - Phone:305-248-5446
Mailing Address - Fax:800-956-2030
Practice Address - Street 1:10200 W STATE ROAD 84
Practice Address - Street 2:SUITE # 204
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4204
Practice Address - Country:US
Practice Address - Phone:305-245-5446
Practice Address - Fax:800-956-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty