Provider Demographics
NPI:1952842973
Name:MABA THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:MABA THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAY DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:786-923-6326
Mailing Address - Street 1:16679 SW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5783
Mailing Address - Country:US
Mailing Address - Phone:786-923-6326
Mailing Address - Fax:
Practice Address - Street 1:16679 SW 80TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5783
Practice Address - Country:US
Practice Address - Phone:786-923-6326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty