Healthcare Provider Details

I. General information

NPI: 1366497042
Provider Name (Legal Business Name): BRIAN ENGE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ROPER MOUNTAIN RD STE H2
GREENVILLE SC
29615-4242
US

IV. Provider business mailing address

440 ROPER MOUNTAIN RD STE H2
GREENVILLE SC
29615-4242
US

V. Phone/Fax

Practice location:
  • Phone: 864-284-0056
  • Fax: 864-284-0059
Mailing address:
  • Phone: 864-284-0056
  • Fax: 864-284-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5246
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: