Healthcare Provider Details

I. General information

NPI: 1164668638
Provider Name (Legal Business Name): MIAMI CHILDREN'S THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 04/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20120 NE 22ND AVE
MIAMI FL
33180-1846
US

IV. Provider business mailing address

20120 NE 22ND AVE
MIAMI FL
33180-1846
US

V. Phone/Fax

Practice location:
  • Phone: 305-528-7217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SANFORD
Title or Position: OWNER
Credential:
Phone: 305-949-7665