Provider Demographics
NPI:1407131626
Name:SIMPSON, BRANDI SUZANNE (LMT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SUZANNE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 OVERSEAS HIGHWAY #3
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050
Mailing Address - Country:US
Mailing Address - Phone:305-289-6220
Mailing Address - Fax:
Practice Address - Street 1:5800 OVERSEAS HWY STE 3
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2736
Practice Address - Country:US
Practice Address - Phone:305-289-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist