MEDICARE: ELISSA LEE SOPHIA GARRETT

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1134083413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA LEE SOPHIA GARRETT

Provider Business Mailing Address
First Line	:	1320 CULVER DR NE STE 3
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 CULVER DR NE STE 3
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1104
Country	:	US
Telephone Number	:	321-914-4055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

Similar Medicare Providers

1518820299 — SKYLAR LOWERY
Practice Location Address:

1320 CULVER DR NE STE 3
PALM BAY, FL
32907-1104

Practice Phone: 321-914-4055
Practice Fax:

1033328661 — ADRIENNE MICHELLE MONICA RBT
Practice Location Address:

1320 CULVER DR NE STE 3
PALM BAY, FL
32907-1104

Practice Phone: 614-747-2763
Practice Fax:

1669790507 — DR. RODERICK JOSEPH KIRK D.C.
Practice Location Address:

1320 CULVER DR NE STE 4
PALM BAY, FL
32907-1104

Practice Phone: 321-473-8185
Practice Fax:

1619284668 — BRAINWORKS FUNCTIONAL NEUROLOGY AND CHIROPRACTIC CENTER
Practice Location Address:

1320 CULVER DR NE , SUITE 4
PALM BAY, FL
32907-1104

Practice Phone: 321-473-8185
Practice Fax:

1801290689 — RYAN OWENS
Practice Location Address:

1320 CULVER DR NE
PALM BAY, FL
32907-1104

Practice Phone: 321-610-3849
Practice Fax:

1407308463 — AUSTEN ANDREW OWENS
Practice Location Address:

1320 CULVER DR NE
PALM BAY, FL
32907-1104

Practice Phone: 321-610-3849
Practice Fax:

Directions to “ ELISSA LEE SOPHIA GARRETT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.