Healthcare Provider Details

I. General information

NPI: 1942778550
Provider Name (Legal Business Name): CARLI ROVITO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 DONNELL BLVD STE Q
DALEVILLE AL
36322-2111
US

IV. Provider business mailing address

807 DONNELL BLVD STE Q
DALEVILLE AL
36322-2111
US

V. Phone/Fax

Practice location:
  • Phone: 334-709-4386
  • Fax: 334-709-4386
Mailing address:
  • Phone: 334-709-4386
  • Fax: 334-709-4386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-66083
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: