Provider Demographics
NPI:1326324146
Name:ROBERT J. BRYLA
Entity Type:Organization
Organization Name:ROBERT J. BRYLA
Other - Org Name:BRYLA CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRYLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:315-733-1846
Mailing Address - Street 1:1912 SUNSET AVE.
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-733-1846
Mailing Address - Fax:315-733-7518
Practice Address - Street 1:1912 SUNSET AVE.
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-733-1846
Practice Address - Fax:315-733-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30837CMedicare PIN
NYT26284Medicare UPIN