Healthcare Provider Details

I. General information

NPI: 1942892286
Provider Name (Legal Business Name): TLC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 S APOPKA VINELAND RD STE 100
ORLANDO FL
32819-3151
US

IV. Provider business mailing address

15245 SHADY GROVE RD STE 110
ROCKVILLE MD
20850-7202
US

V. Phone/Fax

Practice location:
  • Phone: 404-974-9919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR J DAVIDSON
Title or Position: CEO
Credential:
Phone: 404-974-9919