1245488121 NPI number — SPEECH WORKS PEDIATRIC THERAPY, LLC

Table of content: (NPI 1245488121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245488121 NPI number — SPEECH WORKS PEDIATRIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH WORKS PEDIATRIC THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245488121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 SW 74TH ST STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33143-5150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-446-9935
Provider Business Mailing Address Fax Number:
386-446-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 OFFICE PARK DR UNIT 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM COAST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32137-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-446-9935
Provider Business Practice Location Address Fax Number:
386-446-7777
Provider Enumeration Date:
09/03/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
SOPHIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
386-793-8120

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)