Healthcare Provider Details

I. General information

NPI: 1699923367
Provider Name (Legal Business Name): THERAKIDS PLUS CENTER FOR CHILDREN & ADULTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W SLIGH AVE SUITE 100
TAMPA FL
33604-5893
US

IV. Provider business mailing address

1602 W SLIGH AVE SUITE 100
TAMPA FL
33604-5893
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-1936
  • Fax: 813-873-8837
Mailing address:
  • Phone: 813-873-1936
  • Fax: 813-873-8837

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 TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA3850
License Number StateFL

VIII. Authorized Official

Name: MS. KIMBERLY K BOOTH
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 813-873-1936