Healthcare Provider Details

I. General information

NPI: 1316604572
Provider Name (Legal Business Name): REBECCA CHAB B.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BECCA CHAB B.T.

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE HILLMOOR DR STE B101-103
PORT SAINT LUCIE FL
34952-7553
US

IV. Provider business mailing address

11435 SW VILLAGE PKWY APT 304
PORT SAINT LUCIE FL
34987-2659
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0004
  • Fax:
Mailing address:
  • Phone: 703-424-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: