Individual
BRYAN TREFFLEY BOURCIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(260) 266-4006
(260) 266-4008
Mailing address
11130 PAKVIEW CIRCLE DRIVE, FORT WAYNE, IN 46845-1545
(260) 266-7400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009312A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100257920
GROUP MEDICAID
IN
01
—
156546
GROUP MEDICARE
IN
05
—
200880200A
—
IN
Enumeration date
07/31/2007
Last updated
10/20/2022
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