Healthcare Provider Details

I. General information

NPI: 1306771423
Provider Name (Legal Business Name): ROBERT THOMAS MCCUNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4998 W BROAD ST STE 104
COLUMBUS OH
43228-1647
US

IV. Provider business mailing address

3385 DEVIN RD
GROVE CITY OH
43123-2013
US

V. Phone/Fax

Practice location:
  • Phone: 614-754-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberPRS.007950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: