Healthcare Provider Details

I. General information

NPI: 1366353104
Provider Name (Legal Business Name): REAGAN ROHL RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAIN ST
NASHVILLE TN
37206-3603
US

IV. Provider business mailing address

615 MAIN ST
NASHVILLE TN
37206-3603
US

V. Phone/Fax

Practice location:
  • Phone: 616-279-9346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1575989
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: