Provider Demographics
NPI:1487000584
Name:MEYER, BRETT OLEN (LMT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:OLEN
Last Name:MEYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2805 E OAKLAND PARK BLVD
Mailing Address - Street 2:446
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1813
Mailing Address - Country:US
Mailing Address - Phone:954-804-0303
Mailing Address - Fax:954-766-4688
Practice Address - Street 1:2000 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1120
Practice Address - Country:US
Practice Address - Phone:954-566-4222
Practice Address - Fax:954-766-4688
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA17378225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA17378OtherFL DEPT OF HEALTH, MQA