MEDICARE: THOMAS RAYA 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
1	106S00000X	Behavior Technician	RBT1949156	TX

General Provider Information

NPI Number	:	1720560477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS RAYA RBT

Provider Business Mailing Address
First Line	:	PO BOX 609
Second Line	:
City	:	SUTHERLAND SPRINGS
State	:	TX
Zip	:	78161-0609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 AVOCET
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1387
Country	:	US
Telephone Number	:	956-424-5616
Fax Number	:

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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Directions to “ THOMAS RAYA RBT” Practice Location

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