Provider Demographics
NPI:1407813819
Name:FEAN, BRYAN ARTHUR (PT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ARTHUR
Last Name:FEAN
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 1:3629 MARIAN DR
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-1617
Mailing Address - Country:US
Mailing Address - Phone:215-805-9011
Mailing Address - Fax:
Practice Address - Street 1:3629 MARIAN DR
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-1617
Practice Address - Country:US
Practice Address - Phone:215-805-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001500225100000X
PAPT015008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02691P02Medicare PIN