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General NPI Number Information
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NPI Number | 1033501341
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Entity Type | Organization
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Legal Business Name | FLORIDA INTERACTIVE THERAPY LLC
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 1101 MIRANDA LN STE 131
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City | KISSIMMEE
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State | FL
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Zip | 34741-0769
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Country | US
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Telephone | 407-780-0922
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 MIRANDA LN STE 131
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City | KISSIMMEE
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State | FL
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Zip | 34741-0769
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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 | TITLE MANAGER
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Name | YASHIRA MARYL BATISTA
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Credential | MS CCC-SLP
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Telephone | 407-780-0922
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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 | SA13529
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License Number State | FL
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