Provider Demographics
NPI:1679720411
Name:KORYCINSKI, BRIAN SCOTT (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:KORYCINSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 MASTERS RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-9628
Mailing Address - Country:US
Mailing Address - Phone:315-289-6105
Mailing Address - Fax:
Practice Address - Street 1:7571 STATE ROUTE 54
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9504
Practice Address - Country:US
Practice Address - Phone:607-776-8500
Practice Address - Fax:607-776-8817
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019387225100000X
HI2798225100000X
NY029612-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist