Provider Demographics
NPI:1831332097
Name:VECSEY, BRETT RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:RICHARD
Last Name:VECSEY
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 1:12975 AGUSTIN PL
Mailing Address - Street 2:#417
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2307
Mailing Address - Country:US
Mailing Address - Phone:310-741-8466
Mailing Address - Fax:
Practice Address - Street 1:1714 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4410
Practice Address - Country:US
Practice Address - Phone:310-392-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU517ZMedicare PIN