Provider Demographics
NPI:1790972115
Name:LG THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:LG THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:786-356-4299
Mailing Address - Street 1:5545 NW 194TH CIRCLE TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6138
Mailing Address - Country:US
Mailing Address - Phone:786-356-4299
Mailing Address - Fax:
Practice Address - Street 1:5545 NW 194TH CIRCLE TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-6138
Practice Address - Country:US
Practice Address - Phone:786-356-4299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health