Healthcare Provider Details

I. General information

NPI: 1013926187
Provider Name (Legal Business Name): PEDIATRIC THERAPY SERVICES OF GREATER ORLANDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 06/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S WEST CROWN POINTE RD SUITE 150
WINTER GARDEN FL
34787
US

IV. Provider business mailing address

5036 DR. PHILIPS BLVD. SUITE 364
ORLANDO FL
32819-3319
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8905
  • Fax: 407-905-8958
Mailing address:
  • Phone: 407-491-3825
  • Fax: 407-905-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19866
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7810
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-499
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7850
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA6784
License Number StateFL

VIII. Authorized Official

Name: MRS. TONYA LORENE CARSON
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 407-491-3825