Healthcare Provider Details

I. General information

NPI: 1215025457
Provider Name (Legal Business Name): BRETT PHILIP THOMAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 E GRANT ST STE B
ORLANDO FL
32822-1668
US

IV. Provider business mailing address

4409 HOFFNER AVE # 412
BELLE ISLE FL
32812-2331
US

V. Phone/Fax

Practice location:
  • Phone: 407-747-1222
  • Fax: 407-802-4689
Mailing address:
  • Phone: 407-747-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS6215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: