MEDICARE: SPECIALIZED THERAPY RESOURCES, L.L.C.

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

General Provider Information

NPI Number	:	1730491523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED THERAPY RESOURCES, L.L.C.

Provider Business Mailing Address
First Line	:	4301 DRUID LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1028
Country	:	US
Telephone Number	:	469-348-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 DRUID LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1028
Country	:	US
Telephone Number	:	469-348-8691
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR
Name	:	MS. AMANDA K RUTHERFORD
Credential	:	M.S. CCC/SLP
Telephone Number	:	469-348-8691

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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Directions to “SPECIALIZED THERAPY RESOURCES, L.L.C. ” Practice Location

Language	Start Address	Practice Location

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