Provider Demographics
NPI:1104072008
Name:BRYANT THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:BRYANT THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:CCC
Authorized Official - Phone:601-408-1003
Mailing Address - Street 1:201 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-1935
Mailing Address - Country:US
Mailing Address - Phone:601-408-1003
Mailing Address - Fax:601-582-4258
Practice Address - Street 1:201 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-1935
Practice Address - Country:US
Practice Address - Phone:601-408-1003
Practice Address - Fax:601-582-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty