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General NPI Number Information
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NPI Number | 1013733799
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Entity Type | Organization
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Legal Business Name | EXIT 56 THERAPY GROUP LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 124 JOHN KING RD
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City | CRESTVIEW
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State | FL
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Zip | 32539-8306
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Country | US
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Telephone | 850-634-6020
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Fax | 850-680-6289
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Provider Business Mailing Address
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Address Line | 124 JOHN KING RD
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City | CRESTVIEW
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State | FL
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Zip | 32539-8306
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Country | US
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Telephone | 850-634-6020
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Fax | 850-680-6289
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIELLE GRIFFITH
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Credential |
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Telephone | 850-634-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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