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General NPI Number Information
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NPI Number | 1821460809
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Entity Type | Organization
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Legal Business Name | CHRYSALIS PEDIATRIC REHABILITATION
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 629 MANATEE BAY DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-2800
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Country | US
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Telephone | 754-234-5624
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Fax | 561-828-3199
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Provider Business Mailing Address
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Address Line | 629 MANATEE BAY DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-2800
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Country | US
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Telephone | 754-234-5624
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Fax | 561-828-3199
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Authorized Official
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Title or Position | PRESISDENT
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Name | MS. DONNA RAMOS
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Credential | PT
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Telephone | 754-234-5624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT16228
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License Number State | FL
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