Provider Demographics
NPI:1164564241
Name:PEDITHERAPY INC
Entity Type:Organization
Organization Name:PEDITHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:M. CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:954-385-3456
Mailing Address - Street 1:1605 TOWN CENTER BLVD SUITE A
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3637
Mailing Address - Country:US
Mailing Address - Phone:954-385-3456
Mailing Address - Fax:954-626-1315
Practice Address - Street 1:4155 NW 64TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3043
Practice Address - Country:US
Practice Address - Phone:954-385-3456
Practice Address - Fax:954-616-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1331225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty