Provider Demographics
NPI:1386939361
Name:LY THERAPY CENTER
Entity type:Organization
Organization Name:LY THERAPY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISLEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-401-7046
Mailing Address - Street 1:70 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5256
Mailing Address - Country:US
Mailing Address - Phone:786-401-7046
Mailing Address - Fax:786-536-5635
Practice Address - Street 1:70 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5256
Practice Address - Country:US
Practice Address - Phone:786-401-7046
Practice Address - Fax:786-536-5635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LY THERAPY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
MM27011225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty