Healthcare Provider Details

I. General information

NPI: 1629430392
Provider Name (Legal Business Name): NEW HORIZONS PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 GRANITE CIR
CHULUOTA FL
32766-8843
US

IV. Provider business mailing address

546 GRANITE CIR
CHULUOTA FL
32766-8843
US

V. Phone/Fax

Practice location:
  • Phone: 407-506-6274
  • Fax:
Mailing address:
  • Phone: 407-506-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MEHRING
Title or Position: OWNER/THERAPIST
Credential: OTR/L
Phone: 407-506-6274