Provider Demographics
NPI:1255921649
Name:LEAPSTAR PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:LEAPSTAR PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VEERLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEJIA HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:786-378-0158
Mailing Address - Street 1:8878 PARSONS HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-2314
Mailing Address - Country:US
Mailing Address - Phone:786-378-0158
Mailing Address - Fax:
Practice Address - Street 1:30794 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6009
Practice Address - Country:US
Practice Address - Phone:786-378-0158
Practice Address - Fax:813-437-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty