Provider Demographics
NPI:1407361504
Name:TOLIS THERAPY PEDIATRIC & OUTPATIENT
Entity Type:Organization
Organization Name:TOLIS THERAPY PEDIATRIC & OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOAA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-286-8473
Mailing Address - Street 1:842 PLACID LAKE DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-6833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:842 PLACID LAKE DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-6833
Practice Address - Country:US
Practice Address - Phone:941-286-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18988261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center