Healthcare Provider Details

I. General information

NPI: 1033170105
Provider Name (Legal Business Name): THERAPY ASSOCIATES OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 NW 36TH ST SUITE 305-2
VIRGINIA GARDENS FL
33166-6979
US

IV. Provider business mailing address

6595 NW 36TH ST SUITE 305-2
VIRGINIA GARDENS FL
33166-6979
US

V. Phone/Fax

Practice location:
  • Phone: 305-874-1300
  • Fax: 305-874-1300
Mailing address:
  • Phone: 305-874-1300
  • Fax: 305-874-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNY MONTAGNER
Title or Position: PRESIDENT
Credential: MSCCC-SLP
Phone: 305-491-1032