Healthcare Provider Details

I. General information

NPI: 1174284004
Provider Name (Legal Business Name): MY LEARNING ACADEMY THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 SW 136TH CT
MIAMI FL
33177-7175
US

IV. Provider business mailing address

18951 SW 136TH CT
MIAMI FL
33177-7175
US

V. Phone/Fax

Practice location:
  • Phone: 305-798-8337
  • Fax:
Mailing address:
  • Phone: 305-798-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH ANGULO
Title or Position: OWNER
Credential: MD
Phone: 305-798-8337