Provider Demographics
NPI:1073763538
Name:BRION, CHRISTIAN BULAONG (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BULAONG
Last Name:BRION
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 23RD ST
Mailing Address - Street 2:APT. 03
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3327
Mailing Address - Country:US
Mailing Address - Phone:718-730-0503
Mailing Address - Fax:
Practice Address - Street 1:3023 23RD ST
Practice Address - Street 2:APT. 03
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3327
Practice Address - Country:US
Practice Address - Phone:718-730-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist