Provider Demographics
NPI:1962723445
Name:FROST, BRIAN JOEL (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOEL
Last Name:FROST
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BRICKELL AVE
Mailing Address - Street 2:APT. 807
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3930
Mailing Address - Country:US
Mailing Address - Phone:305-498-5890
Mailing Address - Fax:
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:SUITE 115A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2212
Practice Address - Country:US
Practice Address - Phone:305-598-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist