Provider Demographics
NPI:1720315211
Name:HEADWAY THERAPY P.A.
Entity Type:Organization
Organization Name:HEADWAY THERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:II
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:407-694-4366
Mailing Address - Street 1:14717 YORKSHIRE RUN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7831
Mailing Address - Country:US
Mailing Address - Phone:407-694-4366
Mailing Address - Fax:407-249-2720
Practice Address - Street 1:14717 YORKSHIRE RUN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7831
Practice Address - Country:US
Practice Address - Phone:407-694-4366
Practice Address - Fax:407-249-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty