Provider Demographics
NPI:1801012745
Name:FLYNN, BRETT JM (EMT-P , ATC, CSCS)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:JM
Last Name:FLYNN
Suffix:
Gender:M
Credentials:EMT-P , ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-0672
Mailing Address - Country:US
Mailing Address - Phone:860-434-1701
Mailing Address - Fax:
Practice Address - Street 1:69 LYME ST # 1
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-2335
Practice Address - Country:US
Practice Address - Phone:860-434-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002141146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic