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General NPI Number Information
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NPI Number | 1154468247
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Entity Type | Individual
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Provider Name | BRIAN TRZASKOS PT, LMT, CSCS, CMP
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 2310 MAIN STREET
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City | ESSEX
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State | NY
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Zip | 12936-0000
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Country | US
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Telephone | 518-534-3903
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Fax |
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Provider Business Mailing Address
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Address Line | 61 TUNNEL LN
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City | WILLSBORO
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State | NY
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Zip | 12996-3628
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Country | US
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Telephone | 518-534-3903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013882
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4663
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0183651
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License Number State | NY
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