Provider Demographics
NPI:1467925784
Name:HUTTON, BRYAN W (PT DPT CSCS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:W
Last Name:HUTTON
Suffix:
Gender:M
Credentials:PT DPT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:10438 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1427
Practice Address - Country:US
Practice Address - Phone:804-796-1518
Practice Address - Fax:804-796-1543
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist