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General NPI Number Information
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NPI Number | 1740430958
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Entity Type | Organization
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Legal Business Name | THERAPY DIRECT, LLC
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 470 SPARROW BRACH CIRCLE
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City | ST JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-525-0635
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Fax | 904-287-2492
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Provider Business Mailing Address
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Address Line | 470 SPARROW BRACH CIRCLE
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City | ST JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-525-0635
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Fax | 904-287-2492
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Authorized Official
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Title or Position | OWNER
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Name | MR. NOEL NOSSE
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Credential | OTR/L
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Telephone | 904-525-0635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT11540
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA8670
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT9465
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License Number State | FL
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