Provider Demographics
NPI:1821460809
Name:CHRYSALIS PEDIATRIC REHABILITATION
Entity Type:Organization
Organization Name:CHRYSALIS PEDIATRIC REHABILITATION
Other - Org Name:CHRYSALIS REHABILITATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESISDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:754-234-5624
Mailing Address - Street 1:629 MANATEE BAY DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-2800
Mailing Address - Country:US
Mailing Address - Phone:754-234-5624
Mailing Address - Fax:561-828-3199
Practice Address - Street 1:629 MANATEE BAY DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-2800
Practice Address - Country:US
Practice Address - Phone:754-234-5624
Practice Address - Fax:561-828-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty