Provider Demographics
NPI:1588851018
Name:BARRY BREVIK ORTHOPEDIC REHABILITATION
Entity Type:Organization
Organization Name:BARRY BREVIK ORTHOPEDIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BOERRE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BREVIK
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:724-773-0900
Mailing Address - Street 1:363 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009
Mailing Address - Country:US
Mailing Address - Phone:724-773-0900
Mailing Address - Fax:724-773-0733
Practice Address - Street 1:363 THIRD STREET
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-773-0900
Practice Address - Fax:724-773-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006308L208100000X
PAPT017362208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty