MEDICARE: MR. RYAN HINDERLITER BCBA

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		FL
2	106E00000X	Assistant Behavior Analyst	0-24-14970	FL
3	103K00000X	Behavior Analyst	1-25-82255	FL
4	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1467112441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN HINDERLITER BCBA

Provider Business Mailing Address
First Line	:	235 3RD AVE N UNIT 414
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-3378
Country	:	US
Telephone Number	:	908-514-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 3RD AVE N UNIT 414
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33701-3378
Country	:	US
Telephone Number	:	908-514-2212
Fax Number	:

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

Provider Enumeration Date	:	12/18/2021
Last Update Date	:	12/15/2025

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