Healthcare Provider Details

I. General information

NPI: 1952018350
Provider Name (Legal Business Name): SUPER SCHOOL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W SUNRISE BLVD
PLANTATION FL
33313-6749
US

IV. Provider business mailing address

4343 W SUNRISE BLVD
PLANTATION FL
33313-6749
US

V. Phone/Fax

Practice location:
  • Phone: 954-368-4981
  • Fax:
Mailing address:
  • Phone: 954-368-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TEENA M CEBALLOS
Title or Position: MGR
Credential:
Phone: 562-489-4125