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General NPI Number Information
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NPI Number | 1538690797
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Entity Type | Organization
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Legal Business Name | IMPACT THERAPY GROUP INC
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 7414 SW 129TH CT
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City | MIAMI
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State | FL
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Zip | 33183-3452
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Country | US
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Telephone | 860-416-7248
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Fax |
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Provider Business Mailing Address
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Address Line | 7414 SW 129TH CT
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City | MIAMI
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State | FL
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Zip | 33183-3452
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Country | US
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Telephone | 860-416-7248
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA M CAROSO
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Credential |
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Telephone | 860-416-7248
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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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