Provider Demographics
NPI:1487462503
Name:ALDRICH, BRYAN ADAM (CMT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ADAM
Last Name:ALDRICH
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2218
Mailing Address - Country:US
Mailing Address - Phone:507-461-6581
Mailing Address - Fax:
Practice Address - Street 1:577 STATE AVE STE 4
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2291
Practice Address - Country:US
Practice Address - Phone:504-475-1602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist