Basic Information
| Provider Information | |||||||||
| NPI: | 1154507432 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALL ABOARD THERAPY OF THE TREASURE COAST, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 37TH ST STE C | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329606550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725670061 | ||||||||
| FaxNumber: | 7725670062 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 37TH ST STE C | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329606550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725670061 | ||||||||
| FaxNumber: | 7725670062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | ELLIOTT | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
| AuthorizedOfficialMiddleName: | JONES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7725670061 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MA, CCC-SLP | ||||||||
| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | FL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | FL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 000187500 | 05 | FL | MEDICAID |