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General NPI Number Information
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NPI Number | 1003236993
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Entity Type | Organization
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Legal Business Name | SUNRISE THERAPY SERVICES LLC
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 8951 BONITA BEACH RD SE STE 525317
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4201
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Country | US
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Telephone | 239-300-5966
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Fax |
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Provider Business Mailing Address
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Address Line | 8951 BONITA BEACH RD SE STE 525317
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4201
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Country | US
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Telephone | 239-300-5966
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA ANNE TERRY
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Credential | M.S., CCC-SLP
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Telephone | 239-300-5966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 12253
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License Number State | FL
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