Healthcare Provider Details

I. General information

NPI: 1598470783
Provider Name (Legal Business Name): PDL THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 W FLAGLER ST
MIAMI FL
33144-2601
US

IV. Provider business mailing address

7173 W FLAGLER ST
MIAMI FL
33144-2601
US

V. Phone/Fax

Practice location:
  • Phone: 786-443-4007
  • Fax:
Mailing address:
  • Phone: 786-443-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YORDY JULIAN PONCE DE LEON
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 786-443-4007