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General NPI Number Information
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NPI Number | 1174307151
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Entity Type | Organization
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Legal Business Name | KIDS PLACE PPEC LLC
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 7910 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-4819
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Country | US
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Telephone | 407-455-1739
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Fax |
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Provider Business Mailing Address
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Address Line | 7910 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-4819
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Country | US
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Telephone | 407-455-1739
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARTIN LUGO
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Credential |
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Telephone | 407-848-7785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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