MEDICARE: DR. BRIANA MCCORMICK PT, DPT

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	225100000X	Physical Therapist	29471	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	686675	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1235530577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIANA MCCORMICK PT, DPT

Provider Business Mailing Address
First Line	:	10920 MOSS PARK RD
Second Line	:	STE 212
City	:	ORLANDO
State	:	FL
Zip	:	32832-6087
Country	:	US
Telephone Number	:	407-833-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	10920 MOSS PARK RD STE 212
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-6087
Country	:	US
Telephone Number	:	407-753-2192
Fax Number	:	407-369-4266

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	02/11/2020

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