Healthcare Provider Details

I. General information

NPI: 1194662486
Provider Name (Legal Business Name): CLUBHOUSE PEDIATRIC THERAPY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 SW 152ND PL
MIAMI FL
33185-4826
US

IV. Provider business mailing address

3265 SW 152ND PL
MIAMI FL
33185-4826
US

V. Phone/Fax

Practice location:
  • Phone: 305-609-2845
  • Fax:
Mailing address:
  • Phone: 305-609-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YOSLEYN GARCIA
Title or Position: OWNER
Credential: OTR
Phone: 305-609-2845