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General NPI Number Information
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NPI Number | 1154859874
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Entity Type | Individual
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Provider Name | BRIAN FABRIES PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 253 SAGAMORE PKWY W
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1501
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Country | US
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Telephone | 765-409-8556
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 ABNAKI WAY
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-5488
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Country | US
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Telephone | 765-409-8556
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36002774A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004877A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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