Provider Demographics
NPI:1477992105
Name:BRIMER, MARK ALAN (PHD, PT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:BRIMER
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 LOGGERHEAD ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3845
Mailing Address - Country:US
Mailing Address - Phone:321-508-3250
Mailing Address - Fax:
Practice Address - Street 1:850 LOGGERHEAD ISLAND DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3845
Practice Address - Country:US
Practice Address - Phone:321-508-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist