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NPI Code Detail

MEDICARE: BRYAN CANFIELD

MEDICARE: BRYAN CANFIELD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4880WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528002904
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN CANFIELD
Provider Business Mailing Address
First Line : 1475 W GRAND AVE
Second Line :
City : PORT WASHINGTON
State : WI
Zip : 53074-2074
Country : US
Telephone Number : 262-268-5100
Fax Number : 262-329-2731
Provider Business Practice Location Address
First Line : 1475 W GRAND AVE
Second Line :
City : PORT WASHINGTON
State : WI
Zip : 53074-2074
Country : US
Telephone Number : 262-268-5100
Fax Number : 262-329-2731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 09/20/2023

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