Provider Demographics
NPI:1164700050
Name:BRITO, EZEQUIEL (LMT)
Entity Type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:
Last Name:BRITO
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 1:581 LITTLE RIVER LOOP
Mailing Address - Street 2:APT 164
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1774
Mailing Address - Country:US
Mailing Address - Phone:321-277-7163
Mailing Address - Fax:
Practice Address - Street 1:581 LITTLE RIVER LOOP
Practice Address - Street 2:APT 164
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-1774
Practice Address - Country:US
Practice Address - Phone:321-277-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 64153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist