MEDICARE: UNITED SPEECH AND REHABILITATIVE THERAPY 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	253Z00000X	In Home Supportive Care Agency
2	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1750075073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED SPEECH AND REHABILITATIVE THERAPY LLC

Provider Business Mailing Address
First Line	:	18567 SW 132ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-2903
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1527 RIVERSIDE DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-3815
Country	:	US
Telephone Number	:	786-294-3936
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH PATHOLOGIST
Name	:	KRISTEN COMAS BARDELAS
Credential	:
Telephone Number	:	786-294-3936

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	07/02/2024

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