Provider Demographics
NPI:1689968158
Name:THERAPY SOURCE SOLUTIONS,LLC
Entity Type:Organization
Organization Name:THERAPY SOURCE SOLUTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLANDA
Authorized Official - Middle Name:FAYETTE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:321-724-2911
Mailing Address - Street 1:1917 DAN CT NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3044
Mailing Address - Country:US
Mailing Address - Phone:321-724-2911
Mailing Address - Fax:
Practice Address - Street 1:1917 DAN CT NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3044
Practice Address - Country:US
Practice Address - Phone:321-724-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty