Provider Demographics
NPI:1548292055
Name:HOMAN, BRIAN K (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:HOMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:K
Other - Last Name:HOMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:532 SHETLAND CT
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2513
Mailing Address - Country:US
Mailing Address - Phone:856-345-4830
Mailing Address - Fax:856-853-0769
Practice Address - Street 1:319 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8101
Practice Address - Country:US
Practice Address - Phone:856-395-4373
Practice Address - Fax:856-692-7423
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00274100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
073021Medicare ID - Type Unspecified