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General NPI Number Information
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NPI Number | 1194533661
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Entity Type | Organization
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Legal Business Name | IMAGINATION PEDIATRICS THERAPY CENTER L.L.L.P.
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 8896 SW 129TH TER
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City | MIAMI
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State | FL
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Zip | 33176-5945
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Country | US
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Telephone | 786-873-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 8896 SW 129TH TER
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City | MIAMI
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State | FL
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Zip | 33176-5945
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Country | US
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Telephone | 786-873-4395
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | LAURA SHELLEY CHACON
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Credential |
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Telephone | 786-873-4395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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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 | 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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