Healthcare Provider Details

I. General information

NPI: 1669852182
Provider Name (Legal Business Name): BRETT THOMAS DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
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 AVENUE #412
ORLANDO FL
32812
US

V. Phone/Fax

Practice location:
  • Phone: 407-747-1222
  • Fax: 407-802-4689
Mailing address:
  • Phone: 407-902-7178
  • 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: DR. BRETT PHILIP THOMAS
Title or Position: DOCTOR OF OSTEOPATHY
Credential: D.O.
Phone: 407-902-7178