Healthcare Provider Details

I. General information

NPI: 1528291051
Provider Name (Legal Business Name): THERAPEASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MAIN STREET STE7 UNIT I
DESTIN FL
32541
US

IV. Provider business mailing address

PO BOX 5553
DESTIN FL
32540-5553
US

V. Phone/Fax

Practice location:
  • Phone: 850-337-1378
  • Fax: 888-852-6279
Mailing address:
  • Phone: 850-337-1378
  • Fax: 888-852-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateFL

VIII. Authorized Official

Name: MARY HERNDON
Title or Position: MEMBER
Credential:
Phone: 850-337-1378