Healthcare Provider Details

I. General information

NPI: 1497122725
Provider Name (Legal Business Name): ABSOLUTE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N FERDON BLVD
CRESTVIEW FL
32536-1706
US

IV. Provider business mailing address

930 N FERDON BLVD
CRESTVIEW FL
32536-1706
US

V. Phone/Fax

Practice location:
  • Phone: 850-331-2987
  • Fax: 850-398-5008
Mailing address:
  • Phone: 850-331-2987
  • Fax: 850-398-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 10901
License Number StateFL

VIII. Authorized Official

Name: DEBBY TORRES
Title or Position: SLP/DIRECTOR
Credential:
Phone: 850-331-2987