Provider Demographics
NPI:1275622805
Name:JOYNER, BRIAN K (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:JOYNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 265
Mailing Address - Street 2:
Mailing Address - City:CARE-IN-ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62919
Mailing Address - Country:US
Mailing Address - Phone:618-289-3099
Mailing Address - Fax:618-998-9893
Practice Address - Street 1:2907 WILLIAMSON CO PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-998-9894
Practice Address - Fax:618-998-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K21452Medicare UPIN