Healthcare Provider Details

I. General information

NPI: 1114257557
Provider Name (Legal Business Name): CMD PEDIATRIC THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19376 SW 65TH ST SUITE 102
FORT LAUDERDALE FL
33332-3362
US

IV. Provider business mailing address

19376 SW 65TH ST SUITE 102
FORT LAUDERDALE FL
33332-3362
US

V. Phone/Fax

Practice location:
  • Phone: 954-252-2705
  • Fax: 954-252-0524
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19506
License Number StateFL

VIII. Authorized Official

Name: DR. CHARINA M DESAULNIERS
Title or Position: PRESIDENT
Credential: DPT
Phone: 954-252-2705