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Organization
PREMIER PEDIATRIC THERAPY, P.A.
Active
Organization
PREMIER PEDIATRIC THERAPY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURA MAC CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(561) 670-4864
Entity
Organization
Contact information
Practice address
1080 E INDIANTOWN RD STE 104, JUPITER, FL 33477-5188
(561) 670-4864
(561) 258-0812
Mailing address
1080 E INDIANTOWN RD STE 104, JUPITER, FL 33477-5188
(561) 670-4864
(561) 258-0812
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA8369
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003349800
—
FL
05
—
890294100
—
FL
Enumeration date
04/10/2013
Last updated
01/18/2016
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