Provider Demographics
NPI:1467920249
Name:HOME SWEET HOME PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:HOME SWEET HOME PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:SUEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:954-579-5619
Mailing Address - Street 1:11246 SW OLMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1945
Mailing Address - Country:US
Mailing Address - Phone:954-579-5619
Mailing Address - Fax:
Practice Address - Street 1:11246 SW OLMSTEAD DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-1945
Practice Address - Country:US
Practice Address - Phone:954-579-5619
Practice Address - Fax:772-673-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty