Provider Demographics
NPI:1114257557
Name:CMD PEDIATRIC THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CMD PEDIATRIC THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESAULNIERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-252-2705
Mailing Address - Street 1:19376 SW 65TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19376 SW 65TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-3362
Practice Address - Country:US
Practice Address - Phone:954-252-2705
Practice Address - Fax:954-252-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty