MEDICARE: SPEECH REHAB SERVICES, 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	SA356	FL

General Provider Information

NPI Number	:	1174788491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH REHAB SERVICES, LLC

Provider Business Mailing Address
First Line	:	3154 NW 61ST ST
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-3365
Country	:	US
Telephone Number	:	561-994-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 CHAMPION BLVD
Second Line	:	# G12
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-994-6590
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANET L SANDLER
Credential	:	M.A.
Telephone Number	:	561-994-6590

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	07/25/2008

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Directions to “SPEECH REHAB SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

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