Healthcare Provider Details

I. General information

NPI: 1679550594
Provider Name (Legal Business Name): THERAPY BY DESIGN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17670 NW 78TH AVE SUITE 113
HIALEAH FL
33015-3664
US

IV. Provider business mailing address

17670 NW 78TH AVE SUITE 113
HIALEAH FL
33015-3664
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-5757
  • Fax: 305-512-5755
Mailing address:
  • Phone: 305-512-5757
  • Fax: 305-512-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberHCCR2988
License Number StateFL

VIII. Authorized Official

Name: MR. MILDREYS MARTINEZ
Title or Position: ADMINISTRATOR, OCCUPATIONAL THERAPI
Credential: OT
Phone: 305-512-5757