MEDICARE: HOME THERAPY PARTNERS, 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	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1770179798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME THERAPY PARTNERS, LLC

Provider Business Mailing Address
First Line	:	10605 MOORE RD
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-4704
Country	:	US
Telephone Number	:	407-988-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	10605 MOORE RD
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-4704
Country	:	US
Telephone Number	:	407-988-7556
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIO STA MARIA
Credential	:
Telephone Number	:	407-988-7556

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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