Provider Demographics
NPI:1932107992
Name:CARDIN, BRIAN D (PT, CPED)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:CARDIN
Suffix:
Gender:M
Credentials:PT, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E POMFRET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2579
Mailing Address - Country:US
Mailing Address - Phone:717-245-0400
Mailing Address - Fax:717-243-5688
Practice Address - Street 1:290 E POMFRET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2579
Practice Address - Country:US
Practice Address - Phone:717-245-0400
Practice Address - Fax:717-243-5688
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013395L225100000X
PACPED 1742224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058448MV7Medicare ID - Type UnspecifiedMC PROVIDER NUMTER
PA058448U1SMedicare PIN
PA5874630001Medicare NSC