Provider Demographics
NPI:1144663022
Name:BRETT, SHIRLEY ELIZABETH (LMT)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ELIZABETH
Last Name:BRETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BOSTON AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4731
Mailing Address - Country:US
Mailing Address - Phone:407-288-8257
Mailing Address - Fax:
Practice Address - Street 1:106 BOSTON AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4731
Practice Address - Country:US
Practice Address - Phone:407-288-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist