MEDICARE: SMILING KIDZ PPEC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	261QR0400X	Rehabilitation Clinic/Center
4	225XP0200X	Pediatric Occupational Therapist
5	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1477374189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILING KIDZ PPEC LLC

Provider Business Mailing Address
First Line	:	4415 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3513
Country	:	US
Telephone Number	:	954-394-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3513
Country	:	US
Telephone Number	:	954-394-2663
Fax Number	:

Authorized Official
Title or Position	:	OWNER, SMILING KIDZ PPEC LLC
Name	:	WILFREDO LARACUENTE
Credential	:
Telephone Number	:	954-393-3525

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	05/26/2026

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Directions to “SMILING KIDZ PPEC LLC ” Practice Location

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