Organization
ROOTS BEHAVIOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YASHIRA N MARTINEZ (OWNER)
(239) 841-9035
Entity
Organization
Contact information
Practice address
1510 OAK DR, FORT MYERS, FL 33907-2816
(239) 841-9035
Mailing address
1510 OAK DR, FORT MYERS, FL 33907-2816
(239) 841-9035
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021240200
—
FL
Enumeration date
07/20/2021
Last updated
10/21/2021
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