Basic Information
| Provider Information | |||||||||
| NPI: | 1235530577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | BRIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10920 MOSS PARK RD | ||||||||
| Address2: | STE 212 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328326087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078330802 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10920 MOSS PARK RD STE 212 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328326087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077532192 | ||||||||
| FaxNumber: | 4073694266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2014 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 29471 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 686675 | 01 | FL | MEDICARE | OTHER |