Provider Demographics
NPI:1194496679
Name:BRYANT, ANITA L
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 BLACKADORE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-1318
Mailing Address - Country:US
Mailing Address - Phone:412-507-6280
Mailing Address - Fax:412-241-0328
Practice Address - Street 1:1246 BLACKADORE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-1318
Practice Address - Country:US
Practice Address - Phone:412-507-6280
Practice Address - Fax:412-241-0328
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health