Healthcare Provider Details

I. General information

NPI: 1962188771
Provider Name (Legal Business Name): ZACHARY FLYNN RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 ATLANTA STREET
HOLLYWOOD FL
33024
US

IV. Provider business mailing address

300 EAST OAKLAND PARK BLVD #341
WILTON MANORS FL
33334
US

V. Phone/Fax

Practice location:
  • Phone: 954-861-9161
  • Fax:
Mailing address:
  • Phone: 954-861-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: