MEDICARE: BLUE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1720736481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	7108 SW 103RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1377
Country	:	US
Telephone Number	:	786-603-4978
Fax Number	:

Provider Business Practice Location Address
First Line	:	7108 SW 103RD PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1377
Country	:	US
Telephone Number	:	786-603-4978
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANA M TACORONTE MORALES
Credential	:
Telephone Number	:	786-603-4978

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	03/12/2022

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Directions to “BLUE THERAPY SERVICES LLC ” Practice Location

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