Provider Demographics
NPI:1811245384
Name:INFANT AND PEDIATRIC HOME THERAPY
Entity type:Organization
Organization Name:INFANT AND PEDIATRIC HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARINO
Authorized Official - Last Name:PARENTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:954-925-7034
Mailing Address - Street 1:550 SE 4TH CT
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4738
Mailing Address - Country:US
Mailing Address - Phone:954-925-7034
Mailing Address - Fax:954-925-7034
Practice Address - Street 1:550 S.E. 4TH CT
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-0000
Practice Address - Country:US
Practice Address - Phone:954-925-7034
Practice Address - Fax:954-925-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2678252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL810412301Medicaid