Provider Demographics
NPI:1275573198
Name:BRIAND, LARRY D (MS, PT, ATC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:BRIAND
Suffix:
Gender:M
Credentials:MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-3497
Mailing Address - Country:US
Mailing Address - Phone:888-201-1040
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:2717 18TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4666
Practice Address - Country:US
Practice Address - Phone:262-551-5650
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4072024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL87951OtherMEDICARE
IL00186666001OtherMEDICAID
WI40189400Medicaid
WI40189400Medicaid