Healthcare Provider Details

I. General information

NPI: 1801012745
Provider Name (Legal Business Name): BRETT J.M. FLYNN EMT-P , ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 LYME ST # 1
OLD LYME CT
06371-2335
US

IV. Provider business mailing address

PO BOX 672
OLD LYME CT
06371-0672
US

V. Phone/Fax

Practice location:
  • Phone: 860-434-1652
  • Fax:
Mailing address:
  • Phone: 860-434-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number002141
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: