Provider Demographics
NPI:1750754750
Name:KOEWLER, BRYAN J (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:KOEWLER
Suffix:
Gender:M
Credentials:PT, DPT
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 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:812-759-7475
Mailing Address - Fax:
Practice Address - Street 1:826 N SR 161
Practice Address - Street 2:SUITE B
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635
Practice Address - Country:US
Practice Address - Phone:812-627-7007
Practice Address - Fax:812-649-4882
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist