Healthcare Provider Details

I. General information

NPI: 1477682698
Provider Name (Legal Business Name): KIDZ PROGRESSIVE THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 N DIXIE HWY
POMPANO BEACH FL
33064-4207
US

IV. Provider business mailing address

4119 N DIXIE HWY
POMPANO BEACH FL
33064-4207
US

V. Phone/Fax

Practice location:
  • Phone: 954-931-5339
  • Fax:
Mailing address:
  • Phone: 954-931-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 1523
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 253
License Number StateFL

VIII. Authorized Official

Name: MRS. CYNTHIA GLORVINA SHEPPARD
Title or Position: CEO
Credential:
Phone: 954-931-5339