Provider Demographics
NPI:1306828629
Name:WERNER, BRIAN K (MPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:WERNER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9080 W CHEYENNE AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8932
Mailing Address - Country:US
Mailing Address - Phone:702-880-1515
Mailing Address - Fax:702-880-1511
Practice Address - Street 1:5980 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3930
Practice Address - Country:US
Practice Address - Phone:941-894-6848
Practice Address - Fax:941-263-7491
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101173Medicare PIN