Provider Demographics
NPI:1528607009
Name:BROSSIER, SIMON MARIE BENOIT (PT, DPT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:MARIE BENOIT
Last Name:BROSSIER
Suffix:
Gender:M
Credentials:PT, DPT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8005
Mailing Address - Country:US
Mailing Address - Phone:321-842-8307
Mailing Address - Fax:321-842-7464
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8005
Practice Address - Country:US
Practice Address - Phone:321-842-8307
Practice Address - Fax:321-842-7464
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045425225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist