Provider Demographics
NPI:1013955020
Name:ARNY, BRIAN LARRY KIM (P T)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LARRY KIM
Last Name:ARNY
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3089 BESSEMER RD
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-8916
Mailing Address - Country:US
Mailing Address - Phone:269-849-0737
Mailing Address - Fax:
Practice Address - Street 1:183 PEACE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9146
Practice Address - Country:US
Practice Address - Phone:269-408-1636
Practice Address - Fax:269-429-6451
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N80920Medicare ID - Type Unspecified
MIP11540005Medicare ID - Type Unspecified