Provider Demographics
NPI:1194114298
Name:FUSSION THERAPY ,INC
Entity type:Organization
Organization Name:FUSSION THERAPY ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:YEPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-793-0775
Mailing Address - Street 1:9500 NW 77TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 NW 77TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-2502
Practice Address - Country:US
Practice Address - Phone:954-793-0775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2025-01-31
Deactivation Date:2024-11-15
Deactivation Code:
Reactivation Date:2025-01-31
Provider Licenses
StateLicense IDTaxonomies
FLSA12791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006782300Medicaid
FL004719200Medicaid