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NPI Code Detail

MEDICARE: MANDA LANE BRITTSAN PT

MEDICARE: MANDA LANE BRITTSAN 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
1225100000XPhysical TherapistPT007712GA
2225100000XPhysical TherapistPT27119FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790819936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDA LANE BRITTSAN PT
Provider Business Mailing Address
First Line : 1790 SW 43RD WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33317-5701
Country : US
Telephone Number : 855-442-2454
Fax Number : 954-206-7699
Provider Business Practice Location Address
First Line : 1790 SW 43RD WAY
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33317-5701
Country : US
Telephone Number : 855-442-2454
Fax Number : 954-206-7699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 10/08/2018

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Directions to “ MANDA LANE BRITTSAN PT” Practice Location

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