Provider Demographics
NPI:1801177696
Name:CHARTER THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:CHARTER THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:727-207-7271
Mailing Address - Street 1:905 E MARTIN LUTHER KING JR DR STE 400
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4829
Mailing Address - Country:US
Mailing Address - Phone:727-207-7271
Mailing Address - Fax:
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR
Practice Address - Street 2:SUITE 400
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4864
Practice Address - Country:US
Practice Address - Phone:727-207-7271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11077261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech