Provider Demographics
NPI:1760555155
Name:DEAN, BRIAN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 N PERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1129
Mailing Address - Country:US
Mailing Address - Phone:419-523-9003
Mailing Address - Fax:419-523-9143
Practice Address - Street 1:1880 N PERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1129
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:419-523-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist