Organization
SOUTH WALTON ACADEMY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CALLEY G MIDDLEBROOKS DT (DEVELOPMENTAL THERAPIST)
(850) 213-4595
Entity
Organization
Contact information
Practice address
305 MACK BAYOU RD, SANTA ROSA BEACH, FL 32459-7199
(850) 213-4595
(850) 213-4596
Mailing address
305 MACK BAYOU RD, SANTA ROSA BEACH, FL 32459-7199
(850) 213-4595
(850) 213-4596
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255535597
—
FL
Enumeration date
03/08/2018
Last updated
01/25/2021
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