Provider Demographics
NPI:1093106262
Name:OVER THE RAINBOW THERAPY
Entity Type:Organization
Organization Name:OVER THE RAINBOW THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNABELLE
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:3058-077-5566
Mailing Address - Street 1:14435 SW 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7814
Mailing Address - Country:US
Mailing Address - Phone:305-807-7566
Mailing Address - Fax:305-253-7469
Practice Address - Street 1:14435 SW 96TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7814
Practice Address - Country:US
Practice Address - Phone:305-807-7566
Practice Address - Fax:305-253-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL221272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891179700Medicaid