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General NPI Number Information
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NPI Number | 1346384393
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Entity Type | Organization
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Legal Business Name | CHILDREN'S THERAPY AT HOME
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7775 MOKENA CT
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5647
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Country | US
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Telephone | 727-452-6675
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Fax | 727-815-8891
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Provider Business Mailing Address
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Address Line | 7775 MOKENA CT
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-5647
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Country | US
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Telephone | 727-452-6675
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Fax | 727-815-8891
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Authorized Official
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Title or Position | MANAGER
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Name | OLIVER FLORES
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Credential |
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Telephone | 727-452-6675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 12107
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License Number State | FL
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