MEDICARE: MR. BRETT ALAN RICHMAN RPT

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	174400000X	Specialist	PT9631	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y915M	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1437119823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRETT ALAN RICHMAN RPT

Provider Business Mailing Address
First Line	:	7100 FAIRWAY DR
Second Line	:	SUITE #27
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3777
Country	:	US
Telephone Number	:	561-775-7775
Fax Number	:	561-775-7807

Provider Business Practice Location Address
First Line	:	7100 FAIRWAY DR
Second Line	:	#27
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3777
Country	:	US
Telephone Number	:	561-775-7775
Fax Number	:	561-775-7807

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	06/25/2013

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