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General NPI Number Information
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NPI Number | 1811245384
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Entity Type | Organization
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Legal Business Name | INFANT AND PEDIATRIC HOME THERAPY
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 550 S.E. 4TH CT
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City | DANIA
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State | FL
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Zip | 33004-0000
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Country | US
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Telephone | 954-925-7034
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Fax | 954-925-7034
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Provider Business Mailing Address
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Address Line | 550 SE 4TH CT
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City | DANIA
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State | FL
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Zip | 33004-4738
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Country | US
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Telephone | 954-925-7034
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Fax | 954-925-7034
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICHELLE MARINO PARENTE
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Credential | P.T.
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Telephone | 954-925-7034
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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 | PT 2678
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License Number State | FL
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