Provider Demographics
NPI:1679017602
Name:BRENT C STUART LLC
Entity Type:Organization
Organization Name:BRENT C STUART LLC
Other - Org Name:BCS PHYSICAL THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-208-1008
Mailing Address - Street 1:9858 CLINT MOORE ROAD
Mailing Address - Street 2:C111-274
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1034
Mailing Address - Country:US
Mailing Address - Phone:561-482-1144
Mailing Address - Fax:561-482-1145
Practice Address - Street 1:10151 ENTERPRISE CENTER BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3759
Practice Address - Country:US
Practice Address - Phone:561-208-1008
Practice Address - Fax:561-530-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty