Michael Shea Brasher
Individual provider Active NPI Physical Therapist · Eustis, FL
NPI 1114259371 · NPPES record last updated Feb 12, 2010
Key facts
- NPI
- 1114259371
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT25058 (FL)
- Practice address
- 301 S Bay St
Eustis, FL 32726-4005 - Phone
- (662) 809-2677
- NPI assigned
- Feb 12, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT25058 | FL | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT25058 | FL | Yes |
Addresses
Primary practice location
301 S Bay St
Eustis, FL 32726-4005
Mailing address
641 Old Hickory Rd
Grenada, MS 38901-2707
Phone (662) 809-2677
Other providers in Eustis, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.