Provider Demographics
NPI:1245286145
Name:CHILDREN'S THERAPY ASSOCIATES, INC
Entity type:Organization
Organization Name:CHILDREN'S THERAPY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOULANGER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:941-756-1003
Mailing Address - Street 1:3911 GOLF PARK LOOP
Mailing Address - Street 2:SUITE #105
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3453
Mailing Address - Country:US
Mailing Address - Phone:941-756-1003
Mailing Address - Fax:941-756-6003
Practice Address - Street 1:3911 GOLF PARK LOOP
Practice Address - Street 2:SUITE #105
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3453
Practice Address - Country:US
Practice Address - Phone:941-756-1003
Practice Address - Fax:941-756-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902FOtherBLUE CROSS BLUE SHIELD
FL173360OtherWELLCARE