Provider Demographics
NPI:1265896815
Name:TREASURE COAST PEDIATRIC THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:TREASURE COAST PEDIATRIC THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELSAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:772-708-9383
Mailing Address - Street 1:6526 S KANNER HWY
Mailing Address - Street 2:#222
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6396
Mailing Address - Country:US
Mailing Address - Phone:772-708-9383
Mailing Address - Fax:
Practice Address - Street 1:6526 S KANNER HWY
Practice Address - Street 2:#222
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6396
Practice Address - Country:US
Practice Address - Phone:772-708-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty