Provider Demographics
NPI:1013926187
Name:PEDIATRIC THERAPY SERVICES OF GREATER ORLANDO, LLC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES OF GREATER ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:LORENE
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:407-491-3825
Mailing Address - Street 1:5036 DR. PHILIPS BLVD.
Mailing Address - Street 2:SUITE 364
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3319
Mailing Address - Country:US
Mailing Address - Phone:407-491-3825
Mailing Address - Fax:407-905-8958
Practice Address - Street 1:301 S WEST CROWN POINTE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787
Practice Address - Country:US
Practice Address - Phone:407-905-8905
Practice Address - Fax:407-905-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7850235Z00000X
FLSA6784235Z00000X
FLPT19866225100000X
FLPT7810225100000X
FLOT-499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120013700Medicaid
FL890158900Medicaid
FL812291100Medicaid