Healthcare Provider Details

I. General information

NPI: 1326344961
Provider Name (Legal Business Name): ACHIEVE PEDIATRIC HOME THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2011
Last Update Date: 01/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WESTRIDGE LN
PALM COAST FL
32164-4034
US

IV. Provider business mailing address

23 WESTRIDGE LN
PALM COAST FL
32164-4034
US

V. Phone/Fax

Practice location:
  • Phone: 386-793-6679
  • Fax: 386-246-3891
Mailing address:
  • Phone: 386-793-6679
  • Fax: 386-246-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3792
License Number StateFL

VIII. Authorized Official

Name: MRS. ROSEMARIE ROY SANTOS
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 386-793-6679