Provider Demographics
NPI:1982315651
Name:FUNCTIONAL SOLUTIONS THERAPY, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL SOLUTIONS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:770-328-4695
Mailing Address - Street 1:PO BOX 560202
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-0202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:# 560202
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-0202
Practice Address - Country:US
Practice Address - Phone:770-328-4695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109410000Medicaid