Organization
123 THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANA TALARICO DE NOLASCO PT (PRESIDENT/OWNER)
(305) 651-9311
Entity
Organization
Contact information
Practice address
3670 N 54TH AVE, HOLLYWOOD, FL 33021-2340
(305) 651-9311
(754) 201-1390
Mailing address
3670 N 54TH AVE, HOLLYWOOD, FL 33021-2340
(754) 201-1390
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT21718
FL
225200000X
Physical Therapy Assistant
PTA19414
FL
225200000X
Physical Therapy Assistant
PTA20109
FL
225200000X
Physical Therapy Assistant
PTA21752
FL
225200000X
Physical Therapy Assistant
PTA22491
FL
235Z00000X
Speech-Language Pathologist
SA10823
FL
235Z00000X
Speech-Language Pathologist
SA11876
FL
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004221900
—
FL
Enumeration date
08/20/2013
Last updated
11/30/2022
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