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NPI Code Detail

MEDICARE: BACK 2 BASICS BEHAVIORAL MANAGEMENT LLC

MEDICARE: BACK 2 BASICS BEHAVIORAL MANAGEMENT LLC
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
1103K00000XBehavior Analyst
2106E00000XAssistant Behavior Analyst
3106S00000XBehavior TechnicianRBT-16-24924FL
4251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11487019063OTHERFLNPI

General Provider Information

NPI Number : 1134638638
Entity Type Code : Organization
Provider Name (Legal Business Name) : BACK 2 BASICS BEHAVIORAL MANAGEMENT LLC
Provider Business Mailing Address
First Line : 342 W 37TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33012-4326
Country : US
Telephone Number : 786-447-2555
Fax Number :
Provider Business Practice Location Address
First Line : 342 W 37TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33012-4326
Country : US
Telephone Number : 786-447-2555
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. ALEXIS JOSE MARTINEZ
Credential : RBT
Telephone Number : 786-447-2555
Provider Enumeration Date : 09/27/2017
Last Update Date : 07/21/2022

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