Provider Demographics
NPI:1063633139
Name:BRETTHAUER, THOMAS G (LMT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:G
Last Name:BRETTHAUER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11318 SW 114TH CIRCLE TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3868
Mailing Address - Country:US
Mailing Address - Phone:305-321-6698
Mailing Address - Fax:
Practice Address - Street 1:11318 SW 114TH CIRCLE TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3868
Practice Address - Country:US
Practice Address - Phone:305-321-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-23528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist