Healthcare Provider Details

I. General information

NPI: 1245830595
Provider Name (Legal Business Name): COMMUNITY CHILDREN'S THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12353 NATALIES COVE RD
COOPER CITY FL
33330
US

IV. Provider business mailing address

12353 NATALIES COVE RD
COOPER CITY FL
33330
US

V. Phone/Fax

Practice location:
  • Phone: 954-680-4219
  • Fax:
Mailing address:
  • Phone: 954-680-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: MS. SARA A PITTS
Title or Position: OWNER
Credential:
Phone: 954-888-8081