Organization
THERAPY SOURCE LLC
Active
Organization
THERAPY SOURCE LLC
Active
Parent organization
CEREBRAL PALSY OF NORTHEAST FLORIDA, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CEREBRAL PALSY OF NORTHEAST FLORIDA, INC.
Authorized official
MS. HOLLY C PETERS (CEO)
(904) 396-1462
Entity
Organization
Contact information
Practice address
3311 BEACH BLVD, JACKSONVILLE, FL 32207-3704
(904) 396-1462
(904) 396-1199
Mailing address
3311 BEACH BLVD, JACKSONVILLE, FL 32207-3704
(904) 396-1462
(904) 396-1199
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/02/2007
Last updated
10/17/2007
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