Provider Demographics
NPI:1366812778
Name:BRIAR, RAEGAN (DPT)
Entity type:Individual
Prefix:
First Name:RAEGAN
Middle Name:
Last Name:BRIAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MORNINGSIDE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-2836
Mailing Address - Country:US
Mailing Address - Phone:914-393-3102
Mailing Address - Fax:
Practice Address - Street 1:420 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-3055
Practice Address - Country:US
Practice Address - Phone:914-827-9070
Practice Address - Fax:914-827-9069
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036705-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036705-1OtherLICENSE