Provider Demographics
NPI:1972056810
Name:EMPIRICAL PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:EMPIRICAL PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAISEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-720-8006
Mailing Address - Street 1:3430 CULLEN LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1107
Mailing Address - Country:US
Mailing Address - Phone:407-720-8006
Mailing Address - Fax:
Practice Address - Street 1:3430 CULLEN LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812-1107
Practice Address - Country:US
Practice Address - Phone:407-720-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12495225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty