Healthcare Provider Details

I. General information

NPI: 1588122675
Provider Name (Legal Business Name): ANGELS VOICES PEDIATRIC THERAPY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 ORANGE DR STE 104
DAVIE FL
33330-4304
US

IV. Provider business mailing address

12555 ORANGE DR STE 104
DAVIE FL
33330-4304
US

V. Phone/Fax

Practice location:
  • Phone: 954-638-8615
  • Fax: 954-239-3902
Mailing address:
  • Phone: 954-638-8615
  • Fax: 954-239-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN N RISTICK
Title or Position: CEO
Credential:
Phone: 954-638-8615