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NPI Code Detail

MEDICARE: NICHOLAS MYLES ECKERT RBT-22-225842

MEDICARE: NICHOLAS MYLES ECKERT RBT-22-225842
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
1106S00000XBehavior TechnicianRBT-22-225842FL

General Provider Information

NPI Number : 1174242978
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS MYLES ECKERT RBT-22-225842
Provider Business Mailing Address
First Line : 623 W WEATHERBEE RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-6957
Country : US
Telephone Number : 772-203-4518
Fax Number :
Provider Business Practice Location Address
First Line : 1688 OLD CYPRESS TRAIL
Second Line :
City : WELLINGTON
State : FL
Zip : 33414
Country : US
Telephone Number : 561-214-0375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2022
Last Update Date : 08/24/2022

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