Healthcare Provider Details

I. General information

NPI: 1851621833
Provider Name (Legal Business Name): THERAPIST ON THE GO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LEE RD
WINTER PARK FL
32789-1749
US

IV. Provider business mailing address

5367 PENWAY DR
ORLANDO FL
32814-6716
US

V. Phone/Fax

Practice location:
  • Phone: 714-580-4304
  • Fax: 407-629-8600
Mailing address:
  • Phone: 714-580-4304
  • Fax: 407-629-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. TESSA J CARBALLO SCHARF
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: P.T.
Phone: 714-580-4304