Provider Demographics
NPI:1306810601
Name:POWELL, BRIAN M (PT, DPT, OCS, SCS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:POWELL
Suffix:
Gender:M
Credentials:PT, DPT, OCS, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8757 MYLANDER LN
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2102
Mailing Address - Country:US
Mailing Address - Phone:410-823-1336
Mailing Address - Fax:410-823-1384
Practice Address - Street 1:8757 MYLANDER LN
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2102
Practice Address - Country:US
Practice Address - Phone:410-823-1336
Practice Address - Fax:410-823-1384
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD028NMedicare ID - Type Unspecified