MEDICARE: MY THERAPY CENTER, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2355S0801X	Speech-Language Assistant
2	225XP0200X	Pediatric Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710259890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY THERAPY CENTER, INC.

Provider Business Mailing Address
First Line	:	6405 NW 36TH ST STE 105
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6977
Country	:	US
Telephone Number	:	305-526-2426
Fax Number	:	305-526-1182

Provider Business Practice Location Address
First Line	:	6405 NW 36TH ST STE 105
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-6977
Country	:	US
Telephone Number	:	305-526-2426
Fax Number	:	305-526-1182

Authorized Official
Title or Position	:	DIRECTOR
Name	:	REBECA RUIZ
Credential	:	M.S., CCC-SLP
Telephone Number	:	305-526-2426

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	04/15/2014

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Directions to “MY THERAPY CENTER, INC. ” Practice Location

Language	Start Address	Practice Location

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