Provider Demographics
NPI:1073953543
Name:HEALY, BRIAN (LMT,AP,DOM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:HEALY
Suffix:
Gender:M
Credentials:LMT,AP,DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16680 MCGREGOR BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3826
Mailing Address - Country:US
Mailing Address - Phone:239-395-1100
Mailing Address - Fax:866-936-4172
Practice Address - Street 1:16680 MCGREGOR BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3826
Practice Address - Country:US
Practice Address - Phone:239-395-1100
Practice Address - Fax:866-936-4172
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist