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General NPI Number Information
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NPI Number | 1164072815
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Entity Type | Organization
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Legal Business Name | ICBEYOND HOLDINGS, INC.
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Dates
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Enumeration Date | 09/15/2019
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 9024 CARMA DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-1269
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Country | US
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Telephone | 561-827-7336
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Fax | 270-738-5243
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Provider Business Mailing Address
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Address Line | 2200 NW CORPORATE BLVD STE 407
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City | BOCA RATON
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State | FL
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Zip | 33431-7369
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Country | US
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Telephone | 561-827-7336
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Fax | 270-738-5243
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ISIS ROSSO
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Credential | M.S.ED., ITDS
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Telephone | 561-827-7336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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