Provider Demographics
NPI:1427490028
Name:BRYSON, EMILY WARD (PTA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:WARD
Last Name:BRYSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARKET ST
Mailing Address - Street 2:SUITE 4103
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-5635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 MARKET ST
Practice Address - Street 2:SUITE 4103
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-5635
Practice Address - Country:US
Practice Address - Phone:828-877-2110
Practice Address - Fax:828-707-9452
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5159225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA5159OtherLICENSE NUMBER