Organization
KIDS PLACE PPEC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN LUGO (ADMINISTRATOR)
(407) 848-7785
Entity
Organization
Contact information
Practice address
7910 US HIGHWAY 98 N, LAKELAND, FL 33809-4819
(407) 455-1739
Mailing address
7910 US HIGHWAY 98 N, LAKELAND, FL 33809-4819
(407) 455-1739
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
—
—
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
08/22/2023
Last updated
07/12/2024
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