MEDICARE: PETER HORNBUCKLE

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	101Y00000X	Counselor
2	106S00000X	Behavior Technician	RBT-22-231601	FL

General Provider Information

NPI Number	:	1295970705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER HORNBUCKLE

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	13650 W COLONIAL DR STE 150
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3994
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:

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

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	02/28/2023

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Directions to “ PETER HORNBUCKLE ” Practice Location

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