Provider Demographics
NPI:1942413679
Name:BRYNIARSKI, RICHARD J (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:BRYNIARSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14055 S OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9672
Mailing Address - Country:US
Mailing Address - Phone:708-301-8995
Mailing Address - Fax:
Practice Address - Street 1:1240 ESSINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8408
Practice Address - Country:US
Practice Address - Phone:815-744-7108
Practice Address - Fax:815-773-7513
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist