Healthcare Provider Details

I. General information

NPI: 1881401388
Provider Name (Legal Business Name): KIDS OF GOD CENTER CARE PPEC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 E BUSCH BLVD
TAMPA FL
33617-6000
US

IV. Provider business mailing address

4702 E BUSCH BLVD
TAMPA FL
33617-6000
US

V. Phone/Fax

Practice location:
  • Phone: 321-424-1824
  • Fax:
Mailing address:
  • Phone: 321-424-1824
  • Fax:

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 Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETZAIDA PEREZ
Title or Position: OWNER
Credential:
Phone: 321-438-3688