Healthcare Provider Details

I. General information

NPI: 1114765187
Provider Name (Legal Business Name): GRACE MYRR MERISIER RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SW 74TH ST STE 414
MIAMI FL
33143-5164
US

IV. Provider business mailing address

3559 NW 91ST LN
SUNRISE FL
33351-6466
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-359651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: