Provider Demographics
NPI:1831263482
Name:WHOLE-SUM THERAPIES, INC.
Entity type:Organization
Organization Name:WHOLE-SUM THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-730-6988
Mailing Address - Street 1:933 LEE RD STE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5537
Mailing Address - Country:US
Mailing Address - Phone:407-730-6988
Mailing Address - Fax:407-730-6995
Practice Address - Street 1:933 LEE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5551
Practice Address - Country:US
Practice Address - Phone:407-730-6988
Practice Address - Fax:407-730-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688601996OtherMEDICAID WAIVER
FL888283500Medicaid