Healthcare Provider Details

I. General information

NPI: 1689356214
Provider Name (Legal Business Name): TKC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 04/16/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 LITTLE ROAD
NEW PORT RICHEY FL
34655
US

IV. Provider business mailing address

1101 HERR LN
LOUISVILLE KY
40222-4301
US

V. Phone/Fax

Practice location:
  • Phone: 727-564-9938
  • Fax: 727-565-1431
Mailing address:
  • Phone: 502-210-5538
  • Fax: 502-327-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JODY ROGERS
Title or Position: PRESIDENT
Credential:
Phone: 502-210-5538