Healthcare Provider Details

I. General information

NPI: 1497440895
Provider Name (Legal Business Name): LEADING KIDS THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S OCEAN DR APT 1608
HOLLYWOOD FL
33019-2341
US

IV. Provider business mailing address

1000 PARKVIEW DR APT 731
HALLANDALE BEACH FL
33009-2987
US

V. Phone/Fax

Practice location:
  • Phone: 754-757-2757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: MIKHAIL KUCHER
Title or Position: PRESIDENT
Credential:
Phone: 754-754-2757