Provider Demographics
NPI:1467685842
Name:SOUTHEASTERN THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:850-727-7928
Mailing Address - Street 1:2888 MAHAN DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5464
Mailing Address - Country:US
Mailing Address - Phone:850-727-7928
Mailing Address - Fax:850-727-7931
Practice Address - Street 1:2888 MAHAN DR
Practice Address - Street 2:SUITE 3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5464
Practice Address - Country:US
Practice Address - Phone:850-727-7928
Practice Address - Fax:850-727-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001960900Medicaid
FL001960900Medicaid