Provider Demographics
NPI:1710378906
Name:GREEN APPLE PEDIATRIC THERAPY, INC
Entity Type:Organization
Organization Name:GREEN APPLE PEDIATRIC THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-326-1776
Mailing Address - Street 1:917 NW 128TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15715 S DIXIE HWY
Practice Address - Street 2:SUITE 218
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1800
Practice Address - Country:US
Practice Address - Phone:305-985-2977
Practice Address - Fax:877-977-4957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty