Healthcare Provider Details

I. General information

NPI: 1801995774
Provider Name (Legal Business Name): BRETT LLOYD KOLNICK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 NW 2ND AVE STE A6
BOCA RATON FL
33431-6676
US

IV. Provider business mailing address

3350 NW 2ND AVE STE A6
BOCA RATON FL
33431-6676
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-1010
  • Fax: 561-395-1030
Mailing address:
  • Phone: 561-395-1010
  • Fax: 561-395-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT0000007746
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: