Provider Demographics
NPI: | 1851423255 |
---|---|
Name: | ABL THERAPY SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | ABL THERAPY SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LINDA |
Authorized Official - Middle Name: | LEE |
Authorized Official - Last Name: | VINCI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 561-753-1153 |
Mailing Address - Street 1: | 1453 RED PINE TRL |
Mailing Address - Street 2: | |
Mailing Address - City: | WELLINGTON |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33414-5829 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-753-1153 |
Mailing Address - Fax: | 561-753-1341 |
Practice Address - Street 1: | 1453 RED PINE TRL |
Practice Address - Street 2: | |
Practice Address - City: | WELLINGTON |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33414-5829 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-753-1153 |
Practice Address - Fax: | 561-753-1341 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-12 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | L06000083381 | 171W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171W00000X | Other Service Providers | Contractor | Group - Multi-Specialty |