Provider Demographics
NPI:1073729984
Name:PYLE, THERESA
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:PYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3813
Mailing Address - Country:US
Mailing Address - Phone:954-472-3714
Mailing Address - Fax:
Practice Address - Street 1:447 NW 73RD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1608
Practice Address - Country:US
Practice Address - Phone:954-583-7383
Practice Address - Fax:954-583-7388
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist