Provider Demographics
NPI:1831370766
Name:WESTERMANN, BRIAN THOMAS (PTA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:WESTERMANN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1411
Mailing Address - Country:US
Mailing Address - Phone:516-810-1562
Mailing Address - Fax:
Practice Address - Street 1:16405 NORTHCROSS DR STE G2
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5005
Practice Address - Country:US
Practice Address - Phone:888-330-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3922225200000X
NY006709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant