Provider Demographics
NPI:1982801650
Name:KANYER, BRIAN DAVID (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:KANYER
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 1:2200 OAKENWALD DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:IN
Mailing Address - Zip Code:46360-1527
Mailing Address - Country:US
Mailing Address - Phone:219-874-9079
Mailing Address - Fax:
Practice Address - Street 1:2200 OAKENWALD DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:IN
Practice Address - Zip Code:46360-1527
Practice Address - Country:US
Practice Address - Phone:219-874-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001725A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist