MEDICARE: BRYLLE JOSEPH SEBIAL LABRA PT

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	PT36261	FL

General Provider Information

NPI Number	:	1659985745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYLLE JOSEPH SEBIAL LABRA PT

Provider Business Mailing Address
First Line	:	492 6TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-1861
Country	:	US
Telephone Number	:	669-213-8967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 37TH ST STE 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6594
Country	:	US
Telephone Number	:	772-213-9596
Fax Number	:

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

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	10/21/2020

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