Provider Demographics
NPI:1255371803
Name:FEARNLEY, BRIAN J (MPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:FEARNLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8940
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89507
Mailing Address - Country:US
Mailing Address - Phone:775-823-5350
Mailing Address - Fax:775-823-5354
Practice Address - Street 1:5255 LONGLEY LANE SUITE 140
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-823-5350
Practice Address - Fax:775-813-5354
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NV1675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37281Medicare UPIN
NVHB054ZMedicare PIN