Provider Demographics
NPI:1366497042
Name:ENGE, BRIAN (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ENGE
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 1:440 ROPER MOUNTAIN RD
Mailing Address - Street 2:STE H2
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4242
Mailing Address - Country:US
Mailing Address - Phone:864-284-0056
Mailing Address - Fax:864-284-0059
Practice Address - Street 1:440 ROPER MOUNTAIN RD
Practice Address - Street 2:STE H2
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4242
Practice Address - Country:US
Practice Address - Phone:864-284-0056
Practice Address - Fax:864-284-0059
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2507037Medicare ID - Type Unspecified