MEDICARE: SOARING WITH BUTTERFLIES 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1306500822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOARING WITH BUTTERFLIES THERAPY LLC

Provider Business Mailing Address
First Line	:	2831 MAYO ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 MAYO ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5645
Country	:	US
Telephone Number	:	954-371-4660
Fax Number	:

Authorized Official
Title or Position	:	SLP
Name	:	RAQUEL KING
Credential	:	MS, CCC-SLP
Telephone Number	:	954-371-4660

Provider Enumeration Date	:	10/30/2021
Last Update Date	:	10/30/2021

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