Provider Demographics
NPI:1093181026
Name:HALPERT, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:HALPERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 RIDGEBROOK RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9468
Mailing Address - Country:US
Mailing Address - Phone:443-212-5745
Mailing Address - Fax:443-212-5749
Practice Address - Street 1:954 RIDGEBROOK RD STE 330
Practice Address - Street 2:
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9468
Practice Address - Country:US
Practice Address - Phone:443-212-5745
Practice Address - Fax:443-212-5749
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25626208100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25626OtherLICENSE
MD432042ZD6TMedicare PIN