Provider Demographics
NPI:1164852158
Name:SPECTRUM THERAPY INC
Entity Type:Organization
Organization Name:SPECTRUM THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIKAYELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKULINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:561-445-7956
Mailing Address - Street 1:9685 VINEYARD CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4343
Mailing Address - Country:US
Mailing Address - Phone:561-445-7956
Mailing Address - Fax:561-372-0290
Practice Address - Street 1:9685 VINEYARD CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4343
Practice Address - Country:US
Practice Address - Phone:561-445-7956
Practice Address - Fax:561-372-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884400300Medicaid