Provider Demographics
NPI:1972865889
Name:AMERICAN THERAPY HOUSE
Entity Type:Organization
Organization Name:AMERICAN THERAPY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:RETSKE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:954-608-9930
Mailing Address - Street 1:601 NW 96TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6232
Mailing Address - Country:US
Mailing Address - Phone:954-608-9930
Mailing Address - Fax:954-241-6726
Practice Address - Street 1:601 NW 96TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6232
Practice Address - Country:US
Practice Address - Phone:954-608-9930
Practice Address - Fax:954-241-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9537261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888493500Medicaid