MEDICARE: CHASITY GIRTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-22-202685	FL

General Provider Information

NPI Number	:	1104570340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASITY GIRTZ

Provider Business Mailing Address
First Line	:	225 MAIN ST STE 3
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2550
Country	:	US
Telephone Number	:	850-781-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 MAIN ST STE 3
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2550
Country	:	US
Telephone Number	:	850-781-0406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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Directions to “ CHASITY GIRTZ ” Practice Location

Language	Start Address	Practice Location

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