Provider Demographics
NPI:1093380990
Name:PROVISION THERAPY, LLC
Entity Type:Organization
Organization Name:PROVISION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:847-565-9156
Mailing Address - Street 1:3250 DUNLEITH LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3705
Mailing Address - Country:US
Mailing Address - Phone:847-565-9156
Mailing Address - Fax:
Practice Address - Street 1:260 S BUHL FARM DR APT 104
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2529
Practice Address - Country:US
Practice Address - Phone:847-565-9156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty