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Organization

SPTLSC INC

Active
Other names
Sunnyside Pediatric Therapy
Organization subpart
No

Provider details

NPI number
Authorized official
MATTHEW FORD FORD (PRESIDENT)
(609) 432-8983
Entity
Organization

Contact information

Practice address
110 S ORANGE ST, NEW SMYRNA BEACH, FL 32168-7153
(609) 432-8983
Mailing address
1141 SAND TRAP CT, DAYTONA BEACH, FL 32124-3021
(609) 432-8983

Taxonomy

Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary

Other

Enumeration date
06/20/2024
Last updated
08/14/2024
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