Healthcare Provider Details

I. General information

NPI: 1053940114
Provider Name (Legal Business Name): REALTIME THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 79TH TER
PLANTATION FL
33324-1453
US

IV. Provider business mailing address

3901 NW 79TH AVE STE 245 #1029
DORAL FL
33166-6506
US

V. Phone/Fax

Practice location:
  • Phone: 917-676-5493
  • Fax:
Mailing address:
  • Phone: 917-676-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHER OLLIVIERRE
Title or Position: FOUNDER & CEO
Credential: OTD, OTR/L
Phone: 917-676-5493