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NPI Code Detail

MEDICARE: MATTHEW GREGORY RBT

MEDICARE: MATTHEW GREGORY 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
1103K00000XBehavior Analyst1-26-89108FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891572079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW GREGORY RBT
Provider Business Mailing Address
First Line : 495 GRAND BOULEVARD
Second Line : SUITE 206
City : MIRAMAR BEACH
State : FL
Zip : 32550-1408
Country : US
Telephone Number : 850-591-4862
Fax Number :
Provider Business Practice Location Address
First Line : 495 GRAND BOULEVARD
Second Line : SUITE 206
City : MIRAMAR BEACH
State : FL
Zip : 32550-1408
Country : US
Telephone Number : 850-733-9336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2023
Last Update Date : 04/14/2026

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