Provider Demographics
NPI:1992100945
Name:POWERS, BRIAN LAWRENCE (PT, DPT, CCI)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LAWRENCE
Last Name:POWERS
Suffix:
Gender:M
Credentials:PT, DPT, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 UNIVERSITY ESTATES BLVD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2967
Mailing Address - Country:US
Mailing Address - Phone:614-304-2122
Mailing Address - Fax:614-221-9042
Practice Address - Street 1:20 UNIVERSITY ESTATES BLVD UNIT 120
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2967
Practice Address - Country:US
Practice Address - Phone:614-304-2122
Practice Address - Fax:614-221-9042
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-76712251X0800X
OHPT016095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic