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General NPI Number Information
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NPI Number | 1366980187
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Entity Type | Organization
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Legal Business Name | MY PRECIOUS KIDS THERAPY CENTER INC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 4755 SUMMERLIN ROAD SUITE #4
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City | FORT MYERS
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State | FL
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Zip | 33919
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Country | US
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Telephone | 239-292-1838
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Fax | 239-931-6075
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Provider Business Mailing Address
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Address Line | 190 NW 14TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33030-4240
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Country | US
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Telephone | 239-292-1838
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Fax | 239-931-6075
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN NEBLETT
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Credential |
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Telephone | 305-910-3247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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