Provider Demographics
NPI:1447653779
Name:FLORIDA SPEECH & NEUROREHAB CENTER, LLC
Entity type:Organization
Organization Name:FLORIDA SPEECH & NEUROREHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:NOGUERAS
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:305-608-6665
Mailing Address - Street 1:331 SW 184TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5425
Mailing Address - Country:US
Mailing Address - Phone:305-608-6665
Mailing Address - Fax:
Practice Address - Street 1:331 SW 184TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-5425
Practice Address - Country:US
Practice Address - Phone:305-608-6665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10384235Z00000X
FLSA4740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty