MEDICARE: BRETT KARDON LMT

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	MA 74025	FL

General Provider Information

NPI Number	:	1871942615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT KARDON LMT

Provider Business Mailing Address
First Line	:	PO BOX 4451
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33008-4451
Country	:	US
Telephone Number	:	305-409-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	6271 NW 171ST ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4622
Country	:	US
Telephone Number	:	305-409-4035
Fax Number	:

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

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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Directions to “ BRETT KARDON LMT” Practice Location

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