Basic Information
| Provider Information | |||||||||
| NPI: | 1306043435 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRO-THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2303 E FORT KING ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344712559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524017916 | ||||||||
| FaxNumber: | 3523687607 | ||||||||
| Practice Location | |||||||||
| Address1: | 2303 E FORT KING ST | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344712559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524017916 | ||||||||
| FaxNumber: | 3523687607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 09/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | MERCHANT | ||||||||
| AuthorizedOfficialFirstName: | JEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3524017916 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 7027 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.