Provider Demographics
NPI:1538690797
Name:IMPACT THERAPY GROUP INC
Entity Type:Organization
Organization Name:IMPACT THERAPY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAROSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-416-7248
Mailing Address - Street 1:7414 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3452
Mailing Address - Country:US
Mailing Address - Phone:860-416-7248
Mailing Address - Fax:
Practice Address - Street 1:7414 SW 129TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3452
Practice Address - Country:US
Practice Address - Phone:860-416-7248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty