MEDICARE: KIDZ PROGRESSIVE THERAPEUTIC SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT 1523	FL
2	235Z00000X	Speech-Language Pathologist	SA 253	FL

General Provider Information

NPI Number	:	1477682698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDZ PROGRESSIVE THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	4119 N DIXIE HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-4207
Country	:	US
Telephone Number	:	954-931-5339
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 N DIXIE HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-4207
Country	:	US
Telephone Number	:	954-931-5339
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CYNTHIA GLORVINA SHEPPARD
Credential	:
Telephone Number	:	954-931-5339

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/11/2025

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