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General NPI Number Information
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NPI Number | 1114253382
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Entity Type | Organization
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Legal Business Name | VISTA THERAPY SERVICES, PA
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 6634 79 AVE.
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City | PINELLAS PARK
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State | FL
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Zip | 33781
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Country | US
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Telephone | 727-504-6941
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Fax |
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Provider Business Mailing Address
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Address Line | 6634 79 AVE.
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City | PINELLAS PARK
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State | FL
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Zip | 33781
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Country | US
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Telephone | 727-504-6941
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARREN L BENNETT
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Credential | MA,CCC-SLP
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Telephone | 727-504-6941
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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 | SA6805
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License Number State | FL
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