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General NPI Number Information
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NPI Number | 1588851018
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Entity Type | Organization
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Legal Business Name | BARRY BREVIK ORTHOPEDIC REHABILITATION
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 363 THIRD STREET
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City | BEAVER
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State | PA
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Zip | 15009
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Country | US
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Telephone | 724-773-0900
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Fax | 724-773-0733
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Provider Business Mailing Address
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Address Line | 363 THIRD STREET
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City | BEAVER
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State | PA
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Zip | 15009
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Country | US
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Telephone | 724-773-0900
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Fax | 724-773-0733
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Authorized Official
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Title or Position | OWNER PHYSICAL THERAPIST
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Name | MR. BOERRE H BREVIK
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Credential | LPT
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Telephone | 724-773-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT017362
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT006308L
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License Number State | PA
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