Provider Demographics
NPI:1629283502
Name:THE THERAPY PLACE, INC
Entity Type:Organization
Organization Name:THE THERAPY PLACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-824-7772
Mailing Address - Street 1:12221 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5427
Mailing Address - Country:US
Mailing Address - Phone:904-824-7772
Mailing Address - Fax:
Practice Address - Street 1:12221 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5427
Practice Address - Country:US
Practice Address - Phone:904-824-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106571Medicare ID - Type Unspecified