Provider Demographics
NPI:1134878937
Name:KATT, BRIAN DEFREEST (LMT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DEFREEST
Last Name:KATT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 PROVO DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-4106
Mailing Address - Country:US
Mailing Address - Phone:845-702-5096
Mailing Address - Fax:
Practice Address - Street 1:709 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1669
Practice Address - Country:US
Practice Address - Phone:315-937-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032423-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032423-01OtherPRIVATE INSURANCE