Provider Demographics
NPI:1760867410
Name:THERAPEUTIC RECREATIONAL ACTIVITIES, LLC
Entity Type:Organization
Organization Name:THERAPEUTIC RECREATIONAL ACTIVITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-918-2164
Mailing Address - Street 1:12335 NW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3446
Mailing Address - Country:US
Mailing Address - Phone:954-918-2164
Mailing Address - Fax:954-369-4742
Practice Address - Street 1:221 N 46TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6603
Practice Address - Country:US
Practice Address - Phone:954-873-0962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2113432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty