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NPI Code Detail

MEDICARE: MR. ROSS JOHN HEALEA RBT

MEDICARE: MR. ROSS JOHN HEALEA 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
1106S00000XBehavior TechnicianRBT-21-192923IL

General Provider Information

NPI Number : 1619755410
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROSS JOHN HEALEA RBT
Provider Business Mailing Address
First Line : 214 ANTHONY DR APT A
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-6856
Country : US
Telephone Number : 618-420-1243
Fax Number :
Provider Business Practice Location Address
First Line : 411 EDWARDSVILLE RD
Second Line :
City : TROY
State : IL
Zip : 62294-1339
Country : US
Telephone Number : 314-275-0506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2023
Last Update Date : 09/21/2023

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