MEDICARE: RYAN DEAN JAMES 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	103K00000X	Behavior Analyst	24383878	FL

General Provider Information

NPI Number	:	1235615394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DEAN JAMES RBT

Provider Business Mailing Address
First Line	:	13121 ATLANTIC BLVD STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-0102
Country	:	US
Telephone Number	:	850-607-6972
Fax Number	:	850-607-6932

Provider Business Practice Location Address
First Line	:	13121 ATLANTIC BLVD STE 200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-0102
Country	:	US
Telephone Number	:	850-607-6972
Fax Number	:	850-607-6932

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

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	10/09/2024

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Directions to “ RYAN DEAN JAMES RBT” Practice Location

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