Provider Demographics
NPI:1174762074
Name:THERAPY ALLIANCE INC.
Entity type:Organization
Organization Name:THERAPY ALLIANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDRYJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-493-9090
Mailing Address - Street 1:5979 NW 151ST ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2400
Mailing Address - Country:US
Mailing Address - Phone:305-362-3300
Mailing Address - Fax:305-362-0202
Practice Address - Street 1:5979 NW 151ST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2400
Practice Address - Country:US
Practice Address - Phone:305-362-3300
Practice Address - Fax:305-362-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLOT-12003225X00000X
FLSA-8529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000650300Medicaid