Provider Demographics
NPI:1326594599
Name:BRYAN, ALYXANDRA A
Entity type:Individual
Prefix:MRS
First Name:ALYXANDRA
Middle Name:A
Last Name:BRYAN
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 1:825 LOWELL BLVD
Mailing Address - Street 2:A28
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5281
Mailing Address - Country:US
Mailing Address - Phone:850-797-2762
Mailing Address - Fax:
Practice Address - Street 1:22 LAKE BEAUTY DR
Practice Address - Street 2:SUITE 304
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2037
Practice Address - Country:US
Practice Address - Phone:407-896-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17625225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics