Healthcare Provider Details

I. General information

NPI: 1174214100
Provider Name (Legal Business Name): GWYNETH ALEXIS MORRIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N ORLANDO AVE APT 527
MAITLAND FL
32751-4614
US

IV. Provider business mailing address

125 E PINE ST APT 1307
ORLANDO FL
32801-3078
US

V. Phone/Fax

Practice location:
  • Phone: 954-501-5922
  • Fax:
Mailing address:
  • Phone: 954-501-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-274106
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-462056
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: