Provider Demographics
NPI:1790940054
Name:CHOICE PEDIATRIC THERAPY CENTER
Entity Type:Organization
Organization Name:CHOICE PEDIATRIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:MINESH
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:954-349-2922
Mailing Address - Street 1:2751 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3660
Mailing Address - Country:US
Mailing Address - Phone:954-349-2922
Mailing Address - Fax:
Practice Address - Street 1:2751 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3660
Practice Address - Country:US
Practice Address - Phone:954-349-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9969225XP0200X
FLOT 9973225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887708400Medicaid
FL886538800Medicaid