Organization
FULLSAIL THERAPY SERVICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOLLY NIEVES (DIRECTORY OF THERAPY)
(407) 529-5719
Entity
Organization
Contact information
Practice address
2760 DORA AVE, TAVARES, FL 32778-4970
(352) 455-3079
(352) 508-5113
Mailing address
19126 PARK PLACE BLVD, EUSTIS, FL 32736-7261
(352) 455-3079
(352) 508-5113
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
02/17/2023
Last updated
02/17/2023
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