Healthcare Provider Details

I. General information

NPI: 1871164806
Provider Name (Legal Business Name): EVAN MICHAEL ROBERTS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 PINE MARSH LOOP
SAINT CLOUD FL
34771-7407
US

IV. Provider business mailing address

712 LAUREL WAY
CASSELBERRY FL
32707-4811
US

V. Phone/Fax

Practice location:
  • Phone: 407-920-5346
  • Fax: 407-960-3009
Mailing address:
  • Phone: 407-920-0194
  • Fax: 407-920-5346

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: