Healthcare Provider Details

I. General information

NPI: 1861328551
Provider Name (Legal Business Name): RYAN THOMAS GILLEY RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N PARSONS AVE
BRANDON FL
33510-4513
US

IV. Provider business mailing address

1303 GUILES HILL CT
BRANDON FL
33511-7612
US

V. Phone/Fax

Practice location:
  • Phone: 813-407-7275
  • Fax: 813-521-7415
Mailing address:
  • Phone:
  • Fax: 813-521-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-547187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: