MEDICARE: BETANCOURT THERAPY CORP

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
2	261Q00000X	Clinic/Center

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	:	1528613866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETANCOURT THERAPY CORP

Provider Business Mailing Address
First Line	:	6156 SW 158TH PASS
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3696
Country	:	US
Telephone Number	:	786-380-7385
Fax Number	:

Provider Business Practice Location Address
First Line	:	6156 SW 158TH PASS
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3696
Country	:	US
Telephone Number	:	786-380-7385
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. YULEYDIS BETANCOURT MESA
Credential	:	MS, SLP
Telephone Number	:	786-380-7385

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/17/2019

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Directions to “BETANCOURT THERAPY CORP ” Practice Location

Language	Start Address	Practice Location

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