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General NPI Number Information
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NPI Number | 1407361504
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Entity Type | Organization
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Legal Business Name | TOLIS THERAPY PEDIATRIC & OUTPATIENT
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 842 PLACID LAKE DR
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City | OSPREY
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State | FL
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Zip | 34229-6833
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Country | US
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Telephone | 941-286-8473
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Fax |
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Provider Business Mailing Address
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Address Line | 842 PLACID LAKE DR
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City | OSPREY
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State | FL
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Zip | 34229-6833
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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 | OWNER
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Name | DOAA TALEES
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Credential |
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Telephone | 941-286-8473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PT18988
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License Number State | FL
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