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NPI Code Detail

MEDICARE: SKYLAR GRANT RBT

MEDICARE: SKYLAR GRANT RBT
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
1247200000XOther TechnicianRBT-18-62937

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BACBOTHERRBT-18-62937

General Provider Information

NPI Number : 1013473909
Entity Type Code : Individual
Provider Name (Legal Business Name) : SKYLAR GRANT RBT
Provider Business Mailing Address
First Line : 16800 DALLAS PKWY STE 200
Second Line :
City : DALLAS
State : TX
Zip : 75248-1961
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1012 COMMERCIAL BLVD N
Second Line :
City : ARLINGTON
State : TX
Zip : 76001-7119
Country : US
Telephone Number : 817-557-8040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2019
Last Update Date : 02/15/2019

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Directions to “ SKYLAR GRANT RBT” Practice Location

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