Provider Demographics
NPI:1598137200
Name:DY, BRIAN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DY
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10584 MANDEVILLA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6902
Mailing Address - Country:US
Mailing Address - Phone:626-283-1526
Mailing Address - Fax:
Practice Address - Street 1:10584 MANDEVILLA CT
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6902
Practice Address - Country:US
Practice Address - Phone:626-283-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist