MEDICARE: JASON ROSABAL

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-24-380273	FL

General Provider Information

NPI Number	:	1437977030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ROSABAL

Provider Business Mailing Address
First Line	:	9405 BARNSTEAD LN
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4302
Country	:	US
Telephone Number	:	727-967-2809
Fax Number	:	727-807-6032

Provider Business Practice Location Address
First Line	:	13911 LAKESHORE BLVD STE 103
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34667-7102
Country	:	US
Telephone Number	:	727-967-2809
Fax Number	:	727-807-6032

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

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	02/18/2026

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Directions to “ JASON ROSABAL ” Practice Location

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