MEDICARE: THERAPY PALACE 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	:	1841932084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY PALACE LLC

Provider Business Mailing Address
First Line	:	1325 SE 47TH ST UNIT I-3
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 SE 47TH ST UNIT I-3
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9692
Country	:	US
Telephone Number	:	786-616-4689
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELAINE MORALES FRAGINALS
Credential	:
Telephone Number	:	786-616-4689

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	04/08/2022

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Directions to “THERAPY PALACE LLC ” Practice Location

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