=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629283502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE THERAPY PLACE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2007
-----------------------------------------------------
Last Update Date | 01/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12221 W DIXIE HWY
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-5427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-824-7772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12221 W DIXIE HWY
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-5427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-824-7772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR-OWNER
-----------------------------------------------------
Name | MR. THOMAS D PIERCE
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 904-824-7772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------