Provider Demographics
NPI:1215992136
Name:HEALY, BRIAN C (DC, PT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:HEALY
Suffix:
Gender:M
Credentials:DC, PT
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 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:404-367-2095
Mailing Address - Fax:404-817-0737
Practice Address - Street 1:60 11TH ST NE STE 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4346
Practice Address - Country:US
Practice Address - Phone:404-367-2095
Practice Address - Fax:404-367-2095
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017753225100000X
IL038.011704111N00000X
GAPT015108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF754ZOtherMEDICARE PTAN