Provider Demographics
NPI:1871023150
Name:FLORIDA KIDS THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:FLORIDA KIDS THERAPY ASSOCIATES LLC
Other - Org Name:FLORIDA KIDS THERAPY ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-732-0384
Mailing Address - Street 1:17037 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4362
Mailing Address - Country:US
Mailing Address - Phone:786-732-0384
Mailing Address - Fax:
Practice Address - Street 1:17037 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4362
Practice Address - Country:US
Practice Address - Phone:786-732-0384
Practice Address - Fax:305-767-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12521224Z00000X
FLPT263022251P0200X
FLOT8077225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366887341Medicaid
FL1831320126Medicaid