MEDICARE: ABC CHILDREN'S THERAPY, 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	2251P0200X	Pediatric Physical Therapist	PT24392	FL
2	225XP0200X	Pediatric Occupational Therapist	OT12764	FL
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1033438726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC CHILDREN'S THERAPY, LLC

Provider Business Mailing Address
First Line	:	1000 BRICKELL AVE STE 225
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BRICKELL AVE STE 225
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3046
Country	:	US
Telephone Number	:	786-709-8339
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS ANABELA VERA
Credential	:	MSPT
Telephone Number	:	786-709-8339

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	05/20/2010

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