Organization
GO CHECKPOINT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITHRA MINUS (CEO)
(772) 925-9435
Entity
Organization
Contact information
Practice address
5203 LA SALLE ST APT A, FORT PIERCE, FL 34951-5029
(772) 925-9435
Mailing address
5203 LA SALLE ST APT A, FORT PIERCE, FL 34951-5029
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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