MEDICARE: MLU PEDIATRIC 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1104757723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MLU PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	1079 BURTON DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1079 BURTON DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4011
Country	:	US
Telephone Number	:	470-610-3648
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE URKOWITZ
Credential	:
Telephone Number	:	470-610-3648

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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