Provider Demographics
NPI:1457697716
Name:THERAPEDS PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:THERAPEDS PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:THERAPEDS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-494-2643
Mailing Address - Street 1:225 W BUSCH BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7945
Mailing Address - Country:US
Mailing Address - Phone:813-935-3162
Mailing Address - Fax:813-344-0965
Practice Address - Street 1:225 W BUSCH BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7945
Practice Address - Country:US
Practice Address - Phone:813-935-3162
Practice Address - Fax:813-344-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT171362251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty