Healthcare Provider Details

I. General information

NPI: 1720907363
Provider Name (Legal Business Name): K B FAMILY CONNECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3267 SW CONSTELLATION RD,
PORT ST LUCIE FL
34953
US

IV. Provider business mailing address

1193 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34952-5332
US

V. Phone/Fax

Practice location:
  • Phone: 772-207-1091
  • Fax:
Mailing address:
  • Phone: 772-207-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTIAN MONTGOMERY
Title or Position: OWNER
Credential: ITDS
Phone: 772-207-1091