Provider Demographics
NPI:1134317563
Name:FAELLA, BRIAN ANTHONY (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:FAELLA
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 1:129 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5305
Mailing Address - Country:US
Mailing Address - Phone:401-726-7100
Mailing Address - Fax:401-722-9386
Practice Address - Street 1:129 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5305
Practice Address - Country:US
Practice Address - Phone:401-726-7100
Practice Address - Fax:401-722-9386
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist