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General NPI Number Information
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NPI Number | 1225515661
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Entity Type | Individual
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Provider Name | BRIAN NULL PTA
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Gender | Male
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 4501 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778
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Country | US
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Telephone | 843-995-4529
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Fax |
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Provider Business Mailing Address
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Address Line | 2513 CATTLEMEN RD UNIT 2110
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City | SARASOTA
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State | FL
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Zip | 34232-6293
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Country | US
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Telephone | 843-995-4529
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-254526
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA26087
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License Number State | FL
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