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NPI Code Detail

MEDICARE: COURTLAND J THOMAS RBT

MEDICARE: COURTLAND J THOMAS 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-17-35665IN
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1699311282
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTLAND J THOMAS RBT
Provider Business Mailing Address
First Line : 207 MULBERRY ST APT 38
Second Line :
City : HARRISBURG
State : PA
Zip : 17104-3507
Country : US
Telephone Number : 812-972-8890
Fax Number :
Provider Business Practice Location Address
First Line : 1010 N HANCOCK ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19123-2334
Country : US
Telephone Number : 812-972-8890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2019
Last Update Date : 02/18/2021

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