Provider Demographics
NPI:1568597532
Name:HINES, BREN M (LMT)
Entity Type:Individual
Prefix:MS
First Name:BREN
Middle Name:M
Last Name:HINES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:BREN
Other - Middle Name:
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:5200 W NEWBERRY RD
Mailing Address - Street 2:SUITE E4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6104
Mailing Address - Country:US
Mailing Address - Phone:352-222-2000
Mailing Address - Fax:
Practice Address - Street 1:5200 W NEWBERRY RD
Practice Address - Street 2:SUITE E4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6104
Practice Address - Country:US
Practice Address - Phone:352-222-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA31187OtherLICENSE NUMBER