Healthcare Provider Details

I. General information

NPI: 1982209243
Provider Name (Legal Business Name): AMP PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TAVISTOCK LAKES BLVD STE 400
ORLANDO FL
32827-7593
US

IV. Provider business mailing address

6900 TAVISTOCK LAKES BLVD STE 400
ORLANDO FL
32827-7593
US

V. Phone/Fax

Practice location:
  • Phone: 407-970-0824
  • Fax:
Mailing address:
  • Phone: 407-970-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA MARIE PEREZ
Title or Position: OWNER/PT
Credential:
Phone: 407-970-0824