Provider Demographics
NPI:1689711087
Name:RODNER, BRYAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:RODNER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2416
Mailing Address - Country:US
Mailing Address - Phone:267-977-5414
Mailing Address - Fax:
Practice Address - Street 1:1616 WALNUT ST
Practice Address - Street 2:LOWER LOBBY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5313
Practice Address - Country:US
Practice Address - Phone:215-545-5630
Practice Address - Fax:215-732-9988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist