Provider Demographics
NPI:1306934625
Name:BRYANT, ELIZABETH W (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71381
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1381
Mailing Address - Country:US
Mailing Address - Phone:229-434-4774
Mailing Address - Fax:229-434-4775
Practice Address - Street 1:515 N WESTOVER BLVD STE C3
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2145
Practice Address - Country:US
Practice Address - Phone:229-434-4774
Practice Address - Fax:229-434-4775
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ00095Medicare UPIN
GA65BBCHRMedicare ID - Type Unspecified