Provider Demographics
NPI:1992411375
Name:REACTIVE PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:REACTIVE PEDIATRIC THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-201-9163
Mailing Address - Street 1:12695 SW 144TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5991
Mailing Address - Country:US
Mailing Address - Phone:754-201-9163
Mailing Address - Fax:305-408-5780
Practice Address - Street 1:12695 SW 144TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5991
Practice Address - Country:US
Practice Address - Phone:754-201-9163
Practice Address - Fax:305-408-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center