Provider Demographics
NPI:1033234281
Name:LURIE, BRYAN JACOB (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JACOB
Last Name:LURIE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MCCARTNEY ST
Mailing Address - Street 2:APT. 2F
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7647
Mailing Address - Country:US
Mailing Address - Phone:610-330-5919
Mailing Address - Fax:610-330-5811
Practice Address - Street 1:127 A.P. KIRBY SPORTS CENTER
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1772
Practice Address - Country:US
Practice Address - Phone:610-330-5919
Practice Address - Fax:610-330-5811
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer