Provider Demographics
NPI:1912331570
Name:REUTER, BRETT R (PT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:R
Last Name:REUTER
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 1:1857 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3415
Mailing Address - Country:US
Mailing Address - Phone:727-408-5222
Mailing Address - Fax:727-408-5252
Practice Address - Street 1:1857 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3415
Practice Address - Country:US
Practice Address - Phone:727-408-5222
Practice Address - Fax:727-408-5252
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIF213ZMedicare PIN