Provider Demographics
NPI:1982832614
Name:MASINO THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MASINO THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MASINO
Authorized Official - Suffix:II
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-797-6060
Mailing Address - Street 1:1008 AIRPORT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2823
Mailing Address - Country:US
Mailing Address - Phone:850-424-5210
Mailing Address - Fax:850-424-3220
Practice Address - Street 1:1008 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2823
Practice Address - Country:US
Practice Address - Phone:850-424-5210
Practice Address - Fax:850-424-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6559310400000X
FLPY69203104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAW846ZMedicare UPIN
FLAQ454ZMedicare UPIN