Provider Demographics
NPI:1649662057
Name:AT HOME THERAPY, INC
Entity type:Organization
Organization Name:AT HOME THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:FAIRH
Authorized Official - Last Name:RUDDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:561-779-9471
Mailing Address - Street 1:1847 POLO LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6196
Mailing Address - Country:US
Mailing Address - Phone:561-779-9471
Mailing Address - Fax:
Practice Address - Street 1:1847 POLO LAKE DR E
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6196
Practice Address - Country:US
Practice Address - Phone:561-779-9471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-22
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1775251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health