=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578592879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J.L. THERAPY SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 05/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8390 W FLAGLER ST SUITE 208
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-559-1025
-----------------------------------------------------
Fax | 305-559-1554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8390 W FLAGLER ST SUITE 208
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-559-1025
-----------------------------------------------------
Fax | 305-559-1554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR ASSISTANT
-----------------------------------------------------
Name | MRS. LISSETTE VALDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-559-1025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------