Provider Demographics
NPI:1205276540
Name:GARNER, BRYAN ROBERT (DPT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ROBERT
Last Name:GARNER
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 1:1590 E POLSTON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5218
Mailing Address - Country:US
Mailing Address - Phone:208-777-4242
Mailing Address - Fax:208-777-4020
Practice Address - Street 1:1590 E POLSTON AVE
Practice Address - Street 2:STE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5218
Practice Address - Country:US
Practice Address - Phone:208-777-4242
Practice Address - Fax:208-777-4020
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT3241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist