Provider Demographics
NPI:1174631527
Name:HEALEY, BRIAN PAUL (MSPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PAUL
Last Name:HEALEY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13A MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1941
Mailing Address - Country:US
Mailing Address - Phone:973-726-7400
Mailing Address - Fax:973-726-7440
Practice Address - Street 1:13A MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1941
Practice Address - Country:US
Practice Address - Phone:973-726-7400
Practice Address - Fax:973-726-7440
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00819400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist