Organization
KIDSPACE THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAUL SOTO III (DIRECTOR OF OPERATIONS)
(305) 705-7702
Entity
Organization
Contact information
Practice address
15291 NW 60TH AVE STE 101, MIAMI LAKES, FL 33014-2459
(305) 705-7702
Mailing address
15291 NW 60TH AVE STE 101, MIAMI LAKES, FL 33014-2459
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
FL
Enumeration date
07/07/2021
Last updated
07/07/2021
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