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General NPI Number Information
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NPI Number | 1023689106
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Entity Type | Organization
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Legal Business Name | POWER UP PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 7050 ISLA VISTA DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-3065
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Country | US
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Telephone | 443-695-6604
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Fax |
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Provider Business Mailing Address
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Address Line | 7050 ISLA VISTA DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-3065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST (OWNER)
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Name | CHARLES ROBERTSON
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Credential |
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Telephone | 443-695-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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