Provider Demographics
NPI:1407423262
Name:TROOPERS SUPER THERAPY LLC
Entity Type:Organization
Organization Name:TROOPERS SUPER THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-397-3730
Mailing Address - Street 1:4422 SW 129TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4039
Mailing Address - Country:US
Mailing Address - Phone:305-606-7526
Mailing Address - Fax:
Practice Address - Street 1:4422 SW 129TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4039
Practice Address - Country:US
Practice Address - Phone:305-606-7526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty