MEDICARE: PROMISED LAND 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	:	1144086471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISED LAND THERAPY LLC

Provider Business Mailing Address
First Line	:	3333 SOUTHFORK PKWY APT 521
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3769
Country	:	US
Telephone Number	:	314-446-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	4283 E ASHLAND AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-3304
Country	:	US
Telephone Number	:	314-446-9106
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONICA ALICE BROWN
Credential	:	MHS, CCC-SLP
Telephone Number	:	314-446-9106

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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Directions to “PROMISED LAND THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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