Provider Demographics
NPI:1659522803
Name:MERRITT, BRIAN DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:MERRITT
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:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:FIFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54524
Mailing Address - Country:US
Mailing Address - Phone:715-367-3978
Mailing Address - Fax:
Practice Address - Street 1:W 7002 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:FIFIELD
Practice Address - State:WI
Practice Address - Zip Code:54524
Practice Address - Country:US
Practice Address - Phone:715-762-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4650-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist