Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-131233 | TN |
NPI | 1003423781 |
---|---|
Provider Name | Phillip Pearce |
First Address | Bartlett, TN 38134-3867 |
Second Address | Bartlett, TN 38134-3867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2020 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-20-131233 | RBT (01) | TN |