MEDICARE: THERAPEUTIC SPECIALITY SERVICES

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	174400000X	Specialist		FL

General Provider Information

NPI Number	:	1467529180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC SPECIALITY SERVICES

Provider Business Mailing Address
First Line	:	2705 ROBIE AVE
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9619
Country	:	US
Telephone Number	:	352-360-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 ROBIE AVE
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-9619
Country	:	US
Telephone Number	:	352-360-0012
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MICHAEL MARIO SMITH
Credential	:
Telephone Number	:	352-360-0012

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/21/2022

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