Provider Demographics
NPI:1871129981
Name:DELANEY, BRIAN N (LMT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:DELANEY
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 1:3101 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3018
Mailing Address - Country:US
Mailing Address - Phone:414-481-8683
Mailing Address - Fax:
Practice Address - Street 1:3101 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3018
Practice Address - Country:US
Practice Address - Phone:414-481-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist