Provider Demographics
NPI:1851399950
Name:JERVA, BRIAN DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:JERVA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5211
Mailing Address - Country:US
Mailing Address - Phone:267-663-7767
Mailing Address - Fax:215-855-8748
Practice Address - Street 1:3537 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3701
Practice Address - Country:US
Practice Address - Phone:610-723-7771
Practice Address - Fax:610-723-7772
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist