MEDICARE: UNITED THERAPISTS OF SOUTH FLORIDA, 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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1932236296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED THERAPISTS OF SOUTH FLORIDA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 5643
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33310-5643
Country	:	US
Telephone Number	:	954-567-4175
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 W. OAKLAND PARK BLVD.
Second Line	:	STE. #126
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311
Country	:	US
Telephone Number	:	954-567-4175
Fax Number	:

Authorized Official
Title or Position	:	SENIOR MANAGER
Name	:	ALONSO T MANNS
Credential	:	LMFT
Telephone Number	:	954-567-4175

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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