Provider Demographics
NPI:1740463116
Name:THERA WAY INC.
Entity type:Organization
Organization Name:THERA WAY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SAPIO
Authorized Official - Last Name:DOCUMENTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:772-240-5527
Mailing Address - Street 1:443 SE NOME DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-8902
Mailing Address - Country:US
Mailing Address - Phone:772-240-5527
Mailing Address - Fax:772-344-4851
Practice Address - Street 1:443 SE NOME DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-8902
Practice Address - Country:US
Practice Address - Phone:772-240-5527
Practice Address - Fax:772-344-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20821225100000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No251E00000XAgenciesHome Health