Individual
BRIAN NULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4501 WATERMAN WAY, TAVARES, FL 32778
(843) 995-4529
Mailing address
2513 CATTLEMEN RD UNIT 2110, SARASOTA, FL 34232-6293
(843) 995-4529
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-23-254526
FL
225200000X
Physical Therapy Assistant
Primary
PTA26087
FL
Other
Enumeration date
07/27/2018
Last updated
02/08/2023
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