MEDICARE: DR. TERRY ALICIA RUTZ AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AY493	FL

General Provider Information

NPI Number	:	1518929983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY ALICIA RUTZ AU.D.

Provider Business Mailing Address
First Line	:	15280 NW 79TH CT STE 200
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5873
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:	786-907-4485

Provider Business Practice Location Address
First Line	:	3126 N FEDERAL HWY
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6738
Country	:	US
Telephone Number	:	954-785-0900
Fax Number	:	954-786-3497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	12/19/2022

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