# BREVARD PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417671645
- **Authorized official:** ERIK NELSON DPT (OWNER)
- **Authorized official phone:** (321) 848-7695

## Contact information

- **Practice address:** 7756 MANGO GROVE AVE, MELBOURNE, FL 32904-2133
- **Practice address phone:** (321) 848-7695
- **Mailing address:** 7756 MANGO GROVE AVE, MELBOURNE, FL 32904-2133
- **Mailing address phone:** (321) 848-1893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251G0304X | Geriatric Physical Therapist | — | NULL | Yes |
| 2251G0304X | Geriatric Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2022
- **Last updated:** 09/30/2022