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General NPI Number Information
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NPI Number | 1619263845
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Entity Type | Organization
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Legal Business Name | J C ACOSTA THERAPY CORP
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 5851 HOLMBERG RD APT 1124
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City | PARKLAND
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State | FL
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Zip | 33067-4536
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Country | US
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Telephone | 954-907-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 5851 HOLMBERG RD APT 1124
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City | PARKLAND
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State | FL
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Zip | 33067-4536
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Country | US
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Telephone | 954-907-4077
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGY ASSISTANT
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Name | MRS. JENNY CONSTANZA ACOSTA
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Credential | SI 1333
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Telephone | 954-907-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SI 1333
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License Number State | FL
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