Basic Information
| Provider Information | |||||||||
| NPI: | 1992153217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MY FAVORITE THERAPISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1239 E NEWPORT CENTER DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334427711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7544443707 | ||||||||
| FaxNumber: | 7546001967 | ||||||||
| Practice Location | |||||||||
| Address1: | 1239 E NEWPORT CENTER DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334427711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7544443707 | ||||||||
| FaxNumber: | 7546001967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | KATARI | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7544443707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.