Provider Demographics
NPI:1568927747
Name:DEDICATED PEDIATRIC THERAPY INC
Entity Type:Organization
Organization Name:DEDICATED PEDIATRIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-592-6617
Mailing Address - Street 1:261 N UNIVERSITY DR STE 500-26
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2002
Mailing Address - Country:US
Mailing Address - Phone:207-592-6617
Mailing Address - Fax:754-300-1738
Practice Address - Street 1:261 N UNIVERSITY DR STE 500-26
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2002
Practice Address - Country:US
Practice Address - Phone:207-592-6617
Practice Address - Fax:754-300-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720459365Medicaid
FL104007100Medicaid