Healthcare Provider Details

I. General information

NPI: 1760875678
Provider Name (Legal Business Name): FAMILY FIRST THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CRYSTAL GROVE BLVD
LUTZ FL
33548-6409
US

IV. Provider business mailing address

207 CRYSTAL GROVE BLVD
LUTZ FL
33548-6409
US

V. Phone/Fax

Practice location:
  • Phone: 813-848-0341
  • Fax: 813-540-8271
Mailing address:
  • Phone: 813-848-0341
  • Fax: 813-540-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 6573
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSA 6573
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEISHA WILBER VANAMBURG
Title or Position: CEO
Credential: MS CCC-SLP
Phone: 813-389-5301