Provider Demographics
NPI:1750937975
Name:FLORIDA KIDS THERAPY MEDLEY LLC
Entity type:Organization
Organization Name:FLORIDA KIDS THERAPY MEDLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:UMER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT
Authorized Official - Phone:786-702-4663
Mailing Address - Street 1:7261 S WATERWAY DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2766
Mailing Address - Country:US
Mailing Address - Phone:786-702-4663
Mailing Address - Fax:305-767-1461
Practice Address - Street 1:7911 NW 72ND AVE STE 220
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2224
Practice Address - Country:US
Practice Address - Phone:786-702-4663
Practice Address - Fax:305-767-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty