Provider Demographics
NPI:1255505483
Name:JARVIS, BRIAN DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:JARVIS
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 1:20011 BOSTON CROSSCUT RD
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-9660
Mailing Address - Country:US
Mailing Address - Phone:906-483-0192
Mailing Address - Fax:
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:PORTAGE HEALTH SYSTEM
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-9660
Practice Address - Country:US
Practice Address - Phone:906-483-1000
Practice Address - Fax:906-483-1881
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010044592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic