Provider Demographics
NPI:1467786475
Name:CARLYLE THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CARLYLE THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-707-9640
Mailing Address - Street 1:2111 SPRING CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1297
Mailing Address - Country:US
Mailing Address - Phone:561-707-9640
Mailing Address - Fax:561-557-4415
Practice Address - Street 1:2111 SPRING CT
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1297
Practice Address - Country:US
Practice Address - Phone:561-707-9640
Practice Address - Fax:561-557-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001477200Medicaid