Healthcare Provider Details

I. General information

NPI: 1487486916
Provider Name (Legal Business Name): ESCOBAR THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 BENERAID ST
LAND O LAKES FL
34638-7923
US

IV. Provider business mailing address

3821 BENERAID ST
LAND O LAKES FL
34638-7923
US

V. Phone/Fax

Practice location:
  • Phone: 706-201-9237
  • Fax:
Mailing address:
  • Phone: 706-201-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NELLY ESCOBAR
Title or Position: OWNER
Credential: SLPA, MA
Phone: 706-201-9237