Provider Demographics
NPI:1417068529
Name:SOMMER, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SOMMER
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 1:3771 GRANDEVIEW BLVD
Mailing Address - Street 2:APT 227
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:857-205-1005
Mailing Address - Fax:
Practice Address - Street 1:501 E OAK ST
Practice Address - Street 2:SUITE D
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4554
Practice Address - Country:US
Practice Address - Phone:407-847-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22189OtherLICENSE#