Healthcare Provider Details

I. General information

NPI: 1538428446
Provider Name (Legal Business Name): KIDS QUALITY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W 84TH ST SUITE 58
HIALEAH FL
33014-3377
US

IV. Provider business mailing address

1550 W 84TH ST SUITE 58
HIALEAH FL
33014-3377
US

V. Phone/Fax

Practice location:
  • Phone: 305-985-6122
  • Fax: 786-545-7657
Mailing address:
  • Phone: 305-985-6122
  • Fax: 786-545-7657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT26138
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA24257
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT13788
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12054
License Number StateFL

VIII. Authorized Official

Name: DR. JESSIELYNN AVILA
Title or Position: DIRECTOR/OWNER
Credential: DPT
Phone: 305-985-6122