Healthcare Provider Details

I. General information

NPI: 1447148614
Provider Name (Legal Business Name): THE PEACH PIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 S JOG RD
GREENACRES FL
33467-2002
US

IV. Provider business mailing address

9861 ROBINS NEST RD
BOCA RATON FL
33496-2144
US

V. Phone/Fax

Practice location:
  • Phone: 561-517-8227
  • Fax: 561-491-2272
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTINE FRADILLADA
Title or Position: MANAGER
Credential:
Phone: 561-809-5461