MEDICARE: JOHN BRUNNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA100406	FL

General Provider Information

NPI Number	:	1114743077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRUNNER

Provider Business Mailing Address
First Line	:	6576 35TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-7810
Country	:	US
Telephone Number	:	765-414-3041
Fax Number	:

Provider Business Practice Location Address
First Line	:	6576 35TH PL
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-7810
Country	:	US
Telephone Number	:	765-414-3041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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