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General NPI Number Information
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NPI Number | 1184635112
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Entity Type | Organization
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Legal Business Name | THERAPY DYNAMICS
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1710 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-4612
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Country | US
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Telephone | 407-788-7722
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Fax | 407-788-7723
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Provider Business Mailing Address
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Address Line | 1710 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-4612
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Country | US
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Telephone | 407-788-7722
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Fax | 407-788-7723
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. RENEE MCCALLA-WATSON
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Credential |
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Telephone | 407-788-7722
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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 |
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License Number State |
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