MEDICARE: BRIAN DAVID KANYER PT

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
1	174400000X	Specialist	05001725A	IN

General Provider Information

NPI Number	:	1982801650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DAVID KANYER PT

Provider Business Mailing Address
First Line	:	2200 OAKENWALD DR
Second Line	:
City	:	LONG BEACH
State	:	IN
Zip	:	46360-1527
Country	:	US
Telephone Number	:	219-874-9079
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 OAKENWALD DR
Second Line	:
City	:	LONG BEACH
State	:	IN
Zip	:	46360-1527
Country	:	US
Telephone Number	:	219-874-9079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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