Healthcare Provider Details

I. General information

NPI: 1285559922
Provider Name (Legal Business Name): COASTAL KIDS THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15465 SW 13TH TER
MIAMI FL
33194-2597
US

IV. Provider business mailing address

15465 SW 13TH TER
MIAMI FL
33194-2597
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-3247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
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: LIDISYS DIAZ
Title or Position: MGR
Credential: OTR/L
Phone: 786-399-3247