MEDICARE: SOUTH TAMPA VOICE THERAPY, LLC

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	235Z00000X	Speech-Language Pathologist	SA7106	FL

General Provider Information

NPI Number	:	1710335500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TAMPA VOICE THERAPY, LLC

Provider Business Mailing Address
First Line	:	3011 N ADAMS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-5325
Country	:	US
Telephone Number	:	813-728-6601
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 N ADAMS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-5325
Country	:	US
Telephone Number	:	813-728-6601
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH PATHOLOGIST
Name	:	CARA BRYAN
Credential	:	MA, CCC/SLP
Telephone Number	:	813-728-6601

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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Directions to “SOUTH TAMPA VOICE THERAPY, LLC ” Practice Location

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