Provider Demographics
NPI:1932790052
Name:LAMA PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:LAMA PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:219-241-3235
Mailing Address - Street 1:1315 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3310
Mailing Address - Country:US
Mailing Address - Phone:813-269-4879
Mailing Address - Fax:813-544-5561
Practice Address - Street 1:1315 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3310
Practice Address - Country:US
Practice Address - Phone:813-269-4879
Practice Address - Fax:813-544-5561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAMA PEDIATRIC THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-01
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty