Healthcare Provider Details

I. General information

NPI: 1538081989
Provider Name (Legal Business Name): PEYTON E DIDRIKSEN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80001 SW 36TH ST
DAVIE FL
33328
US

IV. Provider business mailing address

8870 SW 49TH CT
COOPER CITY FL
33328-3606
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax:
Mailing address:
  • Phone: 954-577-7790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: