Provider Demographics
NPI:1134473119
Name:SPEECH THERAPY BY REGIS, LLC
Entity Type:Organization
Organization Name:SPEECH THERAPY BY REGIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:REGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-251-1543
Mailing Address - Street 1:5555 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6476
Mailing Address - Country:US
Mailing Address - Phone:954-251-1543
Mailing Address - Fax:954-251-1583
Practice Address - Street 1:5555 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6476
Practice Address - Country:US
Practice Address - Phone:954-251-1543
Practice Address - Fax:954-251-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care