Basic Information
| Provider Information | |||||||||
| NPI: | 1528608916 | ||||||||
| 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: | 01/14/2020 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ELLIOTT | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
| AuthorizedOfficialMiddleName: | JONES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7725670061 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALL ABOARD THERAPY OF THE TREASURE COAST, INC | ||||||||
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| AuthorizedOfficialCredential: | M.A., CCC-SLP | ||||||||
| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.