MEDICARE: THU PHAN 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	RBT-26-529817	FL

General Provider Information

NPI Number	:	1881528032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THU PHAN RBT

Provider Business Mailing Address
First Line	:	217 S MATANZAS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3010
Country	:	US
Telephone Number	:	813-250-0482
Fax Number	:	415-480-2496

Provider Business Practice Location Address
First Line	:	217 S MATANZAS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3010
Country	:	US
Telephone Number	:	813-250-0482
Fax Number	:	415-480-2496

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ THU PHAN RBT” Practice Location

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