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General NPI Number Information
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NPI Number | 1568729978
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY EXPERTS, LLC
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 2509 NELA AVE
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City | BELLE ISLE
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State | FL
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Zip | 32809-6170
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Country | US
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Telephone | 407-451-9871
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Fax | 407-704-3955
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Provider Business Mailing Address
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Address Line | 2509 NELA AVE
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City | BELLE ISLE
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State | FL
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Zip | 32809-6170
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Country | US
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Telephone | 407-451-9871
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Fax | 407-704-3955
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. LORI K MITNIK
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Credential | MA, CCC-SLP
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Telephone | 407-451-9871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SA5261
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License Number State | FL
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