Provider Demographics
NPI:1518380088
Name:CENTER FOR ADVANCED PEDIATRIC SPEECH THERAPY
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED PEDIATRIC SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-571-5322
Mailing Address - Street 1:10275 COLLINS AVE
Mailing Address - Street 2:SUITE 531
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1417
Mailing Address - Country:US
Mailing Address - Phone:786-571-5322
Mailing Address - Fax:
Practice Address - Street 1:10275 COLLINS AVE
Practice Address - Street 2:SUITE 531
Practice Address - City:BAL HARBOUR
Practice Address - State:FL
Practice Address - Zip Code:33154-1417
Practice Address - Country:US
Practice Address - Phone:786-571-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000812500Medicaid