Provider Demographics
NPI:1801995774
Name:KOLNICK, BRETT LLOYD (PT)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:LLOYD
Last Name:KOLNICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 NW 2ND AVE STE A6
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6676
Mailing Address - Country:US
Mailing Address - Phone:561-395-1010
Mailing Address - Fax:561-395-1030
Practice Address - Street 1:3350 NW 2ND AVE STE A6
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6676
Practice Address - Country:US
Practice Address - Phone:561-395-1010
Practice Address - Fax:561-395-1030
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000077462251S0007X
FL39526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650004Medicare PIN
TN36500043Medicare PIN
TN36500044Medicare PIN
TN36500042Medicare PIN
TN3650004Medicare PIN
TN0677340003Medicare NSC
TN0677340001Medicare NSC
TN36500043Medicare PIN
TN36500042Medicare PIN