Provider Demographics
NPI:1033501341
Name:FLORIDA INTERACTIVE THERAPY LLC
Entity Type:Organization
Organization Name:FLORIDA INTERACTIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TITLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YASHIRA
Authorized Official - Middle Name:MARYL
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:407-780-0922
Mailing Address - Street 1:1101 MIRANDA LN
Mailing Address - Street 2:STE 131
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 MIRANDA LN
Practice Address - Street 2:STE 131
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0769
Practice Address - Country:US
Practice Address - Phone:407-780-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty