Brian Scott Michno
Individual provider Active NPI Physical Therapist · Heathrow, FL
NPI 1710116017 · NPPES record last updated Jul 8, 2009
Key facts
- NPI
- 1710116017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 12211 (NC)
- Practice address
- 1485 International Pkwy
2051
Heathrow, FL 32746-5303 - Phone
- (800) 798-6035
- NPI assigned
- Jul 8, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 12211 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Voyage Staffing | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12211 | NC | Yes |
Addresses
Primary practice location
1485 International Pkwy
2051
Heathrow, FL 32746-5303
Mailing address
105 1St St # B
St Augustine, FL 32080-6364
Other providers in Heathrow, FL
- Kenneth H Lucas
- Patrick Lupton
- Chad Magilke
- Robert Martinez
- April Faith Mathews
- Panagiotis Mitropoulos
- Karen Moore
- New Beginnings Private Care, LLC
- Lisa Ngo
- Diem Nguyen
All providers in Heathrow, FL · Physical Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2009. 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.