MEDICARE: SOUTHEASTERN THERAPY 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

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	:	1467685842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2888 MAHAN DR
Second Line	:	SUITE 3
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5464
Country	:	US
Telephone Number	:	850-727-7928
Fax Number	:	850-727-7931

Provider Business Practice Location Address
First Line	:	2888 MAHAN DR
Second Line	:	SUITE 3
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5464
Country	:	US
Telephone Number	:	850-727-7928
Fax Number	:	850-727-7931

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA MARKS
Credential	:	M.S. CCC/SLP
Telephone Number	:	850-727-7928

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/09/2015

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