Provider Demographics
NPI:1629321138
Name:PEDIATRIC THERAPY CENTER
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEYTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:305-866-1966
Mailing Address - Street 1:1166 KANE CONCOURSE STE 202
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2023
Mailing Address - Country:US
Mailing Address - Phone:305-866-1966
Mailing Address - Fax:305-866-1988
Practice Address - Street 1:1166 KANE CONCOURSE STE 202
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2023
Practice Address - Country:US
Practice Address - Phone:305-866-1966
Practice Address - Fax:305-866-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 11765225200000X
FLOT 9913225XP0200X
FLSI21362355S0801X
FLSI 19892355S0801X
FLSI 21222355S0801X
FLSA 9000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty