Provider Demographics
NPI:1164179511
Name:PATH THERAPY CENTER CORP
Entity Type:Organization
Organization Name:PATH THERAPY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-886-8695
Mailing Address - Street 1:75 HARNESS LN # IN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7705
Mailing Address - Country:US
Mailing Address - Phone:786-886-8695
Mailing Address - Fax:
Practice Address - Street 1:75 HARNESS LN # IN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-7705
Practice Address - Country:US
Practice Address - Phone:786-886-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty