Provider Demographics
NPI:1427504836
Name:FLORIDA THERAPY ASSOC., INC
Entity type:Organization
Organization Name:FLORIDA THERAPY ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-429-5139
Mailing Address - Street 1:9370 SW 72ND ST STE A213
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5452
Mailing Address - Country:US
Mailing Address - Phone:786-429-5139
Mailing Address - Fax:305-433-7301
Practice Address - Street 1:9370 SW 72 ST, SUITE A-213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:786-429-5139
Practice Address - Fax:305-433-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FMMH6443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty