MEDICARE: BOSS KIDS THERAPY GROUP 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	261Q00000X	Clinic/Center
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1659261626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSS KIDS THERAPY GROUP LLC

Provider Business Mailing Address
First Line	:	409 S DIXIE HWY STE 4&5
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-4404
Country	:	US
Telephone Number	:	561-418-9059
Fax Number	:	561-834-2461

Provider Business Practice Location Address
First Line	:	409 S DIXIE HWY STE 4&5
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33460-4404
Country	:	US
Telephone Number	:	561-418-9059
Fax Number	:	561-834-2461

Authorized Official
Title or Position	:	OWNER
Name	:	SONIA RODRIGUEZ
Credential	:
Telephone Number	:	561-418-9059

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	06/04/2026

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