MEDICARE: ROBERT PEEK III 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
1	106S00000X	Behavior Technician	RBT-22-227890	FL

General Provider Information

NPI Number	:	1144940560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PEEK III RBT

Provider Business Mailing Address
First Line	:	12086 FORT CAROLINE RD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2688
Country	:	US
Telephone Number	:	904-415-1609
Fax Number	:	904-485-8298

Provider Business Practice Location Address
First Line	:	12086 FORT CAROLINE RD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2688
Country	:	US
Telephone Number	:	904-415-1609
Fax Number	:	904-485-8298

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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