Provider Demographics
NPI:1952018350
Name:SUPER SCHOOL THERAPY
Entity type:Organization
Organization Name:SUPER SCHOOL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CEBALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-489-4125
Mailing Address - Street 1:4343 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6749
Mailing Address - Country:US
Mailing Address - Phone:954-368-4981
Mailing Address - Fax:
Practice Address - Street 1:4343 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6749
Practice Address - Country:US
Practice Address - Phone:954-368-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPER SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral DisturbancesGroup - Multi-Specialty