Healthcare Provider Details

I. General information

NPI: 1174762074
Provider Name (Legal Business Name): THERAPY ALLIANCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 N 54TH AVE
HOLLYWOOD FL
33021-2340
US

IV. Provider business mailing address

14040 NW 7TH AVE
MIAMI FL
33168-6809
US

V. Phone/Fax

Practice location:
  • Phone: 305-362-3300
  • Fax: 754-201-1390
Mailing address:
  • Phone: 305-362-3300
  • Fax: 754-201-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-12003
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA-8529
License Number StateFL

VIII. Authorized Official

Name: MARTIN NOLASCO
Title or Position: OWNER
Credential:
Phone: 786-262-4324