Provider Demographics
NPI:1861458358
Name:REYERSON, BRANT JEREMY (MSPT, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:JEREMY
Last Name:REYERSON
Suffix:
Gender:M
Credentials:MSPT, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 PAINE ST SE STE 1AND2
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1451
Mailing Address - Country:US
Mailing Address - Phone:515-984-8200
Mailing Address - Fax:515-984-8008
Practice Address - Street 1:87 PAINE ST SE STE 1AND2
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-1451
Practice Address - Country:US
Practice Address - Phone:515-984-8200
Practice Address - Fax:515-984-8008
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEI19172Medicare PIN
NEI19172006Medicare PIN