MEDICARE: MR. JOSEPH THOMAS UNIACKE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1366757965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH THOMAS UNIACKE

Provider Business Mailing Address
First Line	:	16407 ENCLAVE VILLAGE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-5107
Country	:	US
Telephone Number	:	813-732-3465
Fax Number	:	813-407-4554

Provider Business Practice Location Address
First Line	:	16407 ENCLAVE VILLAGE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-5107
Country	:	US
Telephone Number	:	813-732-3465
Fax Number	:	813-407-4554

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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