Healthcare Provider Details

I. General information

NPI: 1811245384
Provider Name (Legal Business Name): INFANT AND PEDIATRIC HOME THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S.E. 4TH CT
DANIA FL
33004-0000
US

IV. Provider business mailing address

550 SE 4TH CT
DANIA FL
33004-4738
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-7034
  • Fax: 954-925-7034
Mailing address:
  • Phone: 954-925-7034
  • Fax: 954-925-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberPT 2678
License Number StateFL

VIII. Authorized Official

Name: MRS. MICHELLE MARINO PARENTE
Title or Position: OWNER
Credential: P.T.
Phone: 954-925-7034