Provider Demographics
NPI:1346384393
Name:CHILDREN'S THERAPY AT HOME
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-452-6675
Mailing Address - Street 1:7775 MOKENA CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5647
Mailing Address - Country:US
Mailing Address - Phone:727-452-6675
Mailing Address - Fax:727-815-8891
Practice Address - Street 1:7775 MOKENA CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5647
Practice Address - Country:US
Practice Address - Phone:727-452-6675
Practice Address - Fax:727-815-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL121072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty