Provider Demographics
NPI:1679550594
Name:THERAPY BY DESIGN, INC
Entity Type:Organization
Organization Name:THERAPY BY DESIGN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OCCUPATIONAL THERAPI
Authorized Official - Prefix:MR
Authorized Official - First Name:MILDREYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:305-512-5757
Mailing Address - Street 1:17670 NW 78TH AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3664
Mailing Address - Country:US
Mailing Address - Phone:305-512-5757
Mailing Address - Fax:305-512-5755
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3664
Practice Address - Country:US
Practice Address - Phone:305-512-5757
Practice Address - Fax:305-512-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCCR2988261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686723Medicare PIN