Provider Demographics
NPI:1467705665
Name:BRITNELL, TONI LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LYNN
Last Name:BRITNELL
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 1:753 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5211
Mailing Address - Country:US
Mailing Address - Phone:772-237-5961
Mailing Address - Fax:772-237-5964
Practice Address - Street 1:753 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5211
Practice Address - Country:US
Practice Address - Phone:772-237-5961
Practice Address - Fax:772-237-5964
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist