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NPI Code Detail

MEDICARE: ANTHEA JOLIN ROEBACK

MEDICARE: ANTHEA JOLIN ROEBACK
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-19-104867TX

General Provider Information

NPI Number : 1710505219
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHEA JOLIN ROEBACK
Provider Business Mailing Address
First Line : 206 SILVERBROOK LN
Second Line :
City : DICKINSON
State : TX
Zip : 77539-6177
Country : US
Telephone Number : 832-319-4864
Fax Number :
Provider Business Practice Location Address
First Line : 105 E SHADOWBEND AVE
Second Line :
City : FRIENDSWOOD
State : TX
Zip : 77546-3859
Country : US
Telephone Number : 713-893-3906
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2020
Last Update Date : 07/10/2020

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Directions to “ ANTHEA JOLIN ROEBACK ” Practice Location

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