Healthcare Provider Details

I. General information

NPI: 1578356929
Provider Name (Legal Business Name): MGL THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 SW 150TH CT
MIAMI FL
33185-3995
US

IV. Provider business mailing address

3603 SW 150TH CT
MIAMI FL
33185-3995
US

V. Phone/Fax

Practice location:
  • Phone: 786-925-6057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MILADYS GONZALEZ LEON
Title or Position: OWNER
Credential:
Phone: 786-925-6057