MEDICARE: ROYALTY KIDS THERAPY

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	:	1528781457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYALTY KIDS THERAPY

Provider Business Mailing Address
First Line	:	8345 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4846 N UNIVERSITY DR # 247
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33351-4510
Country	:	US
Telephone Number	:	954-905-0724
Fax Number	:	954-827-0266

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHANEL FREEMAN
Credential	:
Telephone Number	:	954-905-0724

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	10/13/2022

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