Provider Demographics
NPI:1366111536
Name:PURE THERAPY ONE LLC.
Entity type:Organization
Organization Name:PURE THERAPY ONE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAKIYA
Authorized Official - Middle Name:TAMARA
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-678-0789
Mailing Address - Street 1:8950 SW 152ND ST UNIT R
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2064
Mailing Address - Country:US
Mailing Address - Phone:786-678-0789
Mailing Address - Fax:786-732-6091
Practice Address - Street 1:8950 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2064
Practice Address - Country:US
Practice Address - Phone:786-678-0789
Practice Address - Fax:786-732-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174200000XOther Service ProvidersMeals
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)