Healthcare Provider Details

I. General information

NPI: 1205276540
Provider Name (Legal Business Name): BRYAN ROBERT GARNER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 E POLSTON AVE STE B
POST FALLS ID
83854-5218
US

IV. Provider business mailing address

1590 E POLSTON AVE STE B
POST FALLS ID
83854-5218
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-4242
  • Fax: 208-777-4020
Mailing address:
  • Phone: 208-777-4242
  • Fax: 208-777-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3241
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: