| Impact Therapy, Llc | |
|
1717 Hermitage Blvd Tallahassee FL 32308-7709 | |
| (850) 325-6301 | |
| (850) 325-6302 |
| Full Name | Impact Therapy, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1717 Hermitage Blvd, Tallahassee, Florida |
| Authorized Official Name and Position | Kelly Quin Prejean (CLINIC DIRECTOR) |
| Authorized Official Contact | 8503256301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Therapy, Llc 1717 Hermitage Blvd Tallahassee FL 32308-7709 Ph: (850) 325-6301 | Impact Therapy, Llc 1717 Hermitage Blvd Tallahassee FL 32308-7709 Ph: (850) 325-6301 |
| NPI Number | 1639749674 |
|---|---|
| Provider Enumeration Date | 07/01/2021 |
| Last Update Date | 06/26/2024 |
| Certification Date | 06/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639749674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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