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NPI Code Detail

MEDICARE: MR. BRIAN TIRRELL RBT

MEDICARE:  MR. BRIAN  TIRRELL  RBT
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-18-58934AZ

General Provider Information

NPI Number : 1376022111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN TIRRELL RBT
Provider Business Mailing Address
First Line : 20860 N TATUM BLVD STE 300
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4283
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20860 N TATUM BLVD STE 300
Second Line :
City : PHOENIX
State : AZ
Zip : 85050-4283
Country : US
Telephone Number : 866-342-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2018
Last Update Date : 08/13/2018

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Directions to “ MR. BRIAN TIRRELL RBT” Practice Location

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