Provider Demographics
NPI:1275605727
Name:DOORLEY, BRIAN PAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PAUL
Last Name:DOORLEY
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 1:3402 N WARREN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AR
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-0047
Mailing Address - Fax:
Practice Address - Street 1:16140 N ARROWHEAD FOUNTAIN CENTER DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PEORIA
Practice Address - State:AR
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-572-6776
Practice Address - Fax:623-572-6962
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ157376Medicare PIN
AZZ63123Medicare PIN
AZ036551Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER