Provider Demographics
NPI:1184425803
Name:BEACH BABY PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:BEACH BABY PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-871-2784
Mailing Address - Street 1:5042 42ND ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4720
Mailing Address - Country:US
Mailing Address - Phone:727-871-2784
Mailing Address - Fax:
Practice Address - Street 1:5042 42ND ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4720
Practice Address - Country:US
Practice Address - Phone:727-871-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty