Healthcare Provider Details

I. General information

NPI: 1710259890
Provider Name (Legal Business Name): MY THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 NW 36TH ST STE 105
VIRGINIA GARDENS FL
33166-6977
US

IV. Provider business mailing address

6405 NW 36TH ST STE 105
VIRGINIA GARDENS FL
33166-6977
US

V. Phone/Fax

Practice location:
  • Phone: 305-526-2426
  • Fax: 305-526-1182
Mailing address:
  • Phone: 305-526-2426
  • Fax: 305-526-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: REBECA RUIZ
Title or Position: DIRECTOR
Credential: M.S., CCC-SLP
Phone: 305-526-2426