Healthcare Provider Details

I. General information

NPI: 1114704749
Provider Name (Legal Business Name): MULTY THERAPY KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 185 KM 0.6 LOTE SONA INDUSTRIAL COMERCIAL LOCAL #1
CANOVANAS PR
00729
US

IV. Provider business mailing address

CARR 185 KM 0.6 LOTE SONA INDUSTRIAL COMERCIAL LOCAL #1
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-615-5575
  • Fax:
Mailing address:
  • Phone: 787-615-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTOR M SIMONS
Title or Position: DIRECTOR
Credential: MD
Phone: 787-615-5575