Basic Information
| Provider Information | |||||||||
| NPI: | 1992845945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACHIEVE THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2736 HOLLYWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330204808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546031881 | ||||||||
| FaxNumber: | 9546035341 | ||||||||
| Practice Location | |||||||||
| Address1: | 2736 HOLLYWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330204808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546031881 | ||||||||
| FaxNumber: | 9546035341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | RESTREPO | ||||||||
| AuthorizedOfficialFirstName: | SANTIAGO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9546031881 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
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 | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 891919400 | 05 | FL | MEDICAID |