Provider Demographics
NPI:1972590735
Name:HORAK, BRIAN T (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:T
Last Name:HORAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 SW OLESON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6877
Mailing Address - Country:US
Mailing Address - Phone:503-245-2420
Mailing Address - Fax:
Practice Address - Street 1:9115 SW OLESON RD STE 206
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6877
Practice Address - Country:US
Practice Address - Phone:503-245-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10346225100000X
CT007712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist