Provider Demographics
NPI:1962899393
Name:THERAPY BEAT 2.0, LLC
Entity type:Organization
Organization Name:THERAPY BEAT 2.0, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SPEECH AND LANGUAGE PATH
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD
Authorized Official - Phone:352-796-1616
Mailing Address - Street 1:990 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-1238
Mailing Address - Country:US
Mailing Address - Phone:352-796-1616
Mailing Address - Fax:352-796-1626
Practice Address - Street 1:990 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-1238
Practice Address - Country:US
Practice Address - Phone:352-796-1616
Practice Address - Fax:352-796-1626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPY BEAT 2.0, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-23
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892163600Medicaid