MEDICARE: A SPECIAL FUTURE ABA THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1821711896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SPECIAL FUTURE ABA THERAPY LLC

Provider Business Mailing Address
First Line	:	6719 WINKLER RD STE 116
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7200
Country	:	US
Telephone Number	:	305-505-9530
Fax Number	:

Provider Business Practice Location Address
First Line	:	6719 WINKLER RD STE 116
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7200
Country	:	US
Telephone Number	:	305-505-9530
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	ROBERTO PEREZ
Credential	:
Telephone Number	:	305-505-9530

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	09/23/2022

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