Healthcare Provider Details

I. General information

NPI: 1770670994
Provider Name (Legal Business Name): INNOVATIVE PEDIATRIC THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2006
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 SORRENTO DR
WESTON FL
33326-4513
US

IV. Provider business mailing address

1461 SORRENTO DR
WESTON FL
33326-4513
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-0773
  • Fax: 954-659-8329
Mailing address:
  • Phone: 954-217-0773
  • Fax: 954-659-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name: MADHUMATTI MERHAI
Title or Position: PRESIDENT
Credential: MS, OTR/L
Phone: 954-599-1405