Therapy Connection of the Treasure Coast

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA10918 Issued in FL

Legal business name

THERAPY CONNECTION OF THE TREASURE COAST

Practice address

549 NW Lake Whitney PL Ste 104
Port St Lucie, FL 34986

Phone

(772) 301-1207

Fax

(772) 301-1255

NPI assigned

Feb 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Justine Theisen, M.A. CCC-SLP

Title

Owner

Phone

(772) 301-1207

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531353600000",
    "number": "1124486949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 NW LAKE WHITNEY PL STE 104",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861606",
            "telephone_number": "772-301-1207",
            "fax_number": "772-301-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 NW LAKE WHITNEY PL STE 104",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "34986",
            "telephone_number": "772-301-1207",
            "fax_number": "772-301-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPY CONNECTION OF THE TREASURE COAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-08",
        "last_updated": "2018-07-12",
        "status": "A",
        "authorized_official_last_name": "THEISEN",
        "authorized_official_first_name": "JUSTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-301-1207",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.A. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA10918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017281400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.