Provider Demographics
NPI:1548241680
Name:TABLEMAN, BRIAN F (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:TABLEMAN
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 1:68 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4303
Mailing Address - Country:US
Mailing Address - Phone:607-759-0737
Mailing Address - Fax:
Practice Address - Street 1:4401 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3514
Practice Address - Country:US
Practice Address - Phone:607-762-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010172225100000X
MD20845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02409438Medicaid
NY02409438Medicaid
S65143Medicare UPIN