Provider Demographics
NPI:1992961973
Name:PHILIPS AUTISM THERAPY CENTER INC
Entity type:Organization
Organization Name:PHILIPS AUTISM THERAPY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:P
Authorized Official - Last Name:DECARO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-432-9418
Mailing Address - Street 1:7777 N WICKHAM RD
Mailing Address - Street 2:SUITE 12-309
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7976
Mailing Address - Country:US
Mailing Address - Phone:888-554-6558
Mailing Address - Fax:321-757-5177
Practice Address - Street 1:2075 MEADOWLANE AVE
Practice Address - Street 2:
Practice Address - City:W. MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904
Practice Address - Country:US
Practice Address - Phone:888-554-6558
Practice Address - Fax:321-757-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 225X00000X, 261QP2000X
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty