MEDICARE: SPEECHRX 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164032611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECHRX LLC

Provider Business Mailing Address
First Line	:	1762 SW CRANE CREEK CIR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2232
Country	:	US
Telephone Number	:	772-214-8655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 SW CRANE CREEK CIR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2232
Country	:	US
Telephone Number	:	772-214-8655
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MEMBER
Name	:	THOMAS G WINTER
Credential	:
Telephone Number	:	772-214-8655

Provider Enumeration Date	:	08/08/2020
Last Update Date	:	03/29/2021

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Directions to “SPEECHRX LLC ” Practice Location

Language	Start Address	Practice Location

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