MEDICARE: MR. JOHN THEODORE WORTHMAN

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-25-406864	FL

General Provider Information

NPI Number	:	1750199659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN THEODORE WORTHMAN

Provider Business Mailing Address
First Line	:	22507 MORNING GLORY CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-6355
Country	:	US
Telephone Number	:	571-465-0642
Fax Number	:

Provider Business Practice Location Address
First Line	:	22507 MORNING GLORY CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-6355
Country	:	US
Telephone Number	:	571-465-0642
Fax Number	:

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

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	03/20/2026

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