Provider Demographics
NPI:1174674451
Name:THERAPIA INC.
Entity Type:Organization
Organization Name:THERAPIA INC.
Other - Org Name:BEACHES REHABILTATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-249-5020
Mailing Address - Street 1:1015 ATLANTIC BLVD # 214
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3313
Mailing Address - Country:US
Mailing Address - Phone:904-249-5020
Mailing Address - Fax:904-241-7777
Practice Address - Street 1:700 3RD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5072
Practice Address - Country:US
Practice Address - Phone:904-249-5020
Practice Address - Fax:904-241-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0701372261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203109800OtherDEPARTMENT OF LABOR
FL7664706OtherAETNA
FLGF6OtherBLUE CROSS BLUE SHIELD
FL7664706OtherAETNA
FLGF6OtherBLUE CROSS BLUE SHIELD