Provider Demographics
NPI:1598086332
Name:POLUDNIAK, BRIAN L (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:POLUDNIAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 LIBERTY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2133
Mailing Address - Country:US
Mailing Address - Phone:440-967-4226
Mailing Address - Fax:440-967-0296
Practice Address - Street 1:4365 LIBERTY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2133
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-0296
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist