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General NPI Number Information
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NPI Number | 1427504836
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Entity Type | Organization
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Legal Business Name | FLORIDA THERAPY ASSOC., INC
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Dates
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Enumeration Date | 08/27/2016
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Last Update Date | 08/27/2016
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Provider Practice Location Address
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Address Line | 9370 SW 72 ST, SUITE A-213
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City | MIAMI
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State | FL
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Zip | 33173
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Country | US
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Telephone | 786-429-5139
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Fax | 305-433-7301
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Provider Business Mailing Address
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Address Line | 9370 SW 72ND ST STE A213
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City | MIAMI
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State | FL
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Zip | 33173-5452
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Country | US
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Telephone | 786-429-5139
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Fax | 305-433-7301
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROSA M VIDAL
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Credential |
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Telephone | 786-429-5139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6443
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License Number State | FM
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