Provider Demographics
NPI:1568729978
Name:PEDIATRIC THERAPY EXPERTS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY EXPERTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:407-451-9871
Mailing Address - Street 1:2509 NELA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32809-6170
Mailing Address - Country:US
Mailing Address - Phone:407-451-9871
Mailing Address - Fax:407-704-3955
Practice Address - Street 1:2509 NELA AVE
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32809-6170
Practice Address - Country:US
Practice Address - Phone:407-451-9871
Practice Address - Fax:407-704-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5261261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech