1255921649 NPI number — LEAPSTAR PEDIATRIC THERAPY, LLC

Table of content: (NPI 1255921649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255921649 NPI number — LEAPSTAR PEDIATRIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEAPSTAR 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:
1255921649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8878 PARSONS HILL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33545-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-378-0158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30794 STATE ROAD 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33543-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-378-0158
Provider Business Practice Location Address Fax Number:
813-437-1428
Provider Enumeration Date:
01/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MEJIA HERNANDEZ
Authorized Official First Name:
VEERLEY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
786-378-0158

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109335500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com