Provider Demographics
NPI:1962426361
Name:BROS, OLIVIER
Entity type:Individual
Prefix:MR
First Name:OLIVIER
Middle Name:
Last Name:BROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4864
Mailing Address - Country:US
Mailing Address - Phone:212-889-3889
Mailing Address - Fax:631-204-1086
Practice Address - Street 1:46 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4864
Practice Address - Country:US
Practice Address - Phone:212-889-3889
Practice Address - Fax:631-204-1086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist