Provider Demographics
NPI:1740229160
Name:BRICE, ANDREW NELSON (PT/ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:NELSON
Last Name:BRICE
Suffix:
Gender:M
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 SE 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668-2147
Mailing Address - Country:US
Mailing Address - Phone:352-486-5758
Mailing Address - Fax:
Practice Address - Street 1:506 SW 5TH TER
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2548
Practice Address - Country:US
Practice Address - Phone:353-528-0022
Practice Address - Fax:352-528-2878
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 80942251S0007X, 2251X0800X
FLAL 4842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4752ZMedicare ID - Type UnspecifiedPHYSICAL THERAPY