Healthcare Provider Details

I. General information

NPI: 1720823545
Provider Name (Legal Business Name): MIAMI THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 NW 2ND TER
MIAMI FL
33126-5007
US

IV. Provider business mailing address

5111 NW 2ND TER
MIAMI FL
33126-5007
US

V. Phone/Fax

Practice location:
  • Phone: 786-574-0496
  • Fax:
Mailing address:
  • Phone: 786-574-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YESENIA DENIS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 786-574-0496