Provider Demographics
NPI:1326365990
Name:THERAPEUTIC EXPRESSIONS REHABILITATION SERVICES
Entity Type:Organization
Organization Name:THERAPEUTIC EXPRESSIONS REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/PARTNER/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOLAJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYSON-LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:863-430-6299
Mailing Address - Street 1:P.O. BOX 2410
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836
Mailing Address - Country:US
Mailing Address - Phone:863-430-6299
Mailing Address - Fax:863-438-4345
Practice Address - Street 1:152 TIGERLILY COURT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33836-2410
Practice Address - Country:US
Practice Address - Phone:863-430-6299
Practice Address - Fax:863-438-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine