Basic Information
| Provider Information | |||||||||
| NPI: | 1609810456 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL FLORIDA THERAPY SOLUTIONS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 W WARREN AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327504002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072600551 | ||||||||
| FaxNumber: | 4072659590 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 W WARREN AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327504002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072600551 | ||||||||
| FaxNumber: | 4072659590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSTON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | CLAUDIA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4072600551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS, CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | PT 3886 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225XP0200X | OT 11334 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 235Z00000X | SA5296 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 28832 | 01 | FL | WELL CARE | OTHER | X1601 | 01 | FL | BCBS | OTHER | Y921D | 01 | FL | BCBS | OTHER | 217278 | 01 | FL | AMERIGROUP | OTHER | 886431400 | 05 | FL | MEDICAID |