MEDICARE: ESCOBAR THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	252Y00000X	Early Intervention Provider Agency
4	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1487486916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESCOBAR THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	3821 BENERAID ST
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-7923
Country	:	US
Telephone Number	:	706-201-9237
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 BENERAID ST
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-7923
Country	:	US
Telephone Number	:	706-201-9237
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NELLY ESCOBAR
Credential	:	SLPA, MA
Telephone Number	:	706-201-9237

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	12/11/2024

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Directions to “ESCOBAR THERAPY SERVICES LLC ” Practice Location

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