Provider Demographics
NPI:1891203402
Name:MIAMI SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:MIAMI SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOIARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-215-8880
Mailing Address - Street 1:10421 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6227
Mailing Address - Country:US
Mailing Address - Phone:305-215-8880
Mailing Address - Fax:
Practice Address - Street 1:10421 SW 50TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6227
Practice Address - Country:US
Practice Address - Phone:305-215-8880
Practice Address - Fax:305-503-9284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty