Provider Demographics
NPI:1922398106
Name:DEVELOPMENTAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:DEVELOPMENTAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:305-967-0605
Mailing Address - Street 1:8620 SW 184TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7236
Mailing Address - Country:US
Mailing Address - Phone:305-967-0605
Mailing Address - Fax:
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:305-967-0605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT178002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty