Provider Demographics
NPI:1447791488
Name:THERAPY DIRECT INC
Entity Type:Organization
Organization Name:THERAPY DIRECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:772-538-8411
Mailing Address - Street 1:5605 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-8022
Mailing Address - Country:US
Mailing Address - Phone:772-538-8411
Mailing Address - Fax:
Practice Address - Street 1:5605 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:FL
Practice Address - Zip Code:32949-8022
Practice Address - Country:US
Practice Address - Phone:772-538-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty