Provider Demographics
NPI:1841573052
Name:FEAN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FEAN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:215-805-9011
Mailing Address - Street 1:3629 MARIAN DR
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-1617
Mailing Address - Country:US
Mailing Address - Phone:215-805-9011
Mailing Address - Fax:206-600-6329
Practice Address - Street 1:3629 MARIAN DR
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-1617
Practice Address - Country:US
Practice Address - Phone:215-805-9011
Practice Address - Fax:206-600-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015008225100000X
DEJ1-0001500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty