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General NPI Number Information
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NPI Number | 1114257557
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Entity Type | Organization
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Legal Business Name | CMD PEDIATRIC THERAPY SERVICES LLC
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 19376 SW 65TH ST SUITE 102
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City | FORT LAUDERDALE
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State | FL
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Zip | 33332-3362
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Country | US
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Telephone | 954-252-2705
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Fax | 954-252-0524
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Provider Business Mailing Address
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Address Line | 19376 SW 65TH ST SUITE 102
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City | FORT LAUDERDALE
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State | FL
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Zip | 33332-3362
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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 | PRESIDENT
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Name | DR. CHARINA M DESAULNIERS
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Credential | DPT
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Telephone | 954-252-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19506
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License Number State | FL
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