| Divine Deliverance Therapy Services, Llc | |
|
5401 S Kirkman Rd Ste 310 Orlando FL 32819-7937 | |
| (407) 719-3024 | |
| Not Available |
| Full Name | Divine Deliverance Therapy Services, Llc |
|---|---|
| Speciality | Speech-Language Pathologist |
| Location | 5401 S Kirkman Rd Ste 310, Orlando, Florida |
| Authorized Official Name and Position | Labrina A Jackson (OWNER) |
| Authorized Official Contact | 4077193024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Deliverance Therapy Services, Llc 5401 S Kirkman Rd Ste 310 Orlando FL 32819-7937 Ph: (866) 330-6427 | Divine Deliverance Therapy Services, Llc 5401 S Kirkman Rd Ste 310 Orlando FL 32819-7937 Ph: (407) 719-3024 |
| NPI Number | 1730612185 |
|---|---|
| Provider Enumeration Date | 04/04/2017 |
| Last Update Date | 03/07/2018 |
| Medicare PECOS PAC ID | 0345501797 |
|---|---|
| Medicare Enrollment ID | O20180227000453 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730612185 | NPI | - | NPPES |
| Provider Name | Labrina Jackson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1902267891 PECOS PAC ID: 0042571499 Enrollment ID: I20180227000732 |
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