Provider Demographics
NPI:1982469342
Name:KIDOZ THERAPY ZONE LLC
Entity Type:Organization
Organization Name:KIDOZ THERAPY ZONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LIZ
Authorized Official - Last Name:DE JESUS VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-250-0626
Mailing Address - Street 1:1024 E OSCEOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1607
Mailing Address - Country:US
Mailing Address - Phone:407-250-0626
Mailing Address - Fax:
Practice Address - Street 1:1502 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3527
Practice Address - Country:US
Practice Address - Phone:407-250-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDOZ THERAPY ZONE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center