MEDICARE: KIND KIDS THERAPY CENTER 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1639904204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIND KIDS THERAPY CENTER LLC

Provider Business Mailing Address
First Line	:	4174 SW 48TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33314-5607
Country	:	US
Telephone Number	:	786-635-7808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4174 SW 48TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33314-5607
Country	:	US
Telephone Number	:	786-635-7808
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SOFIA TORRES
Credential	:
Telephone Number	:	786-635-7808

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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