Provider Demographics
NPI:1528282225
Name:BRYAN-TERRY, SANDRA KAY (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:BRYAN-TERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:KING SALMON
Mailing Address - State:AK
Mailing Address - Zip Code:99613-0335
Mailing Address - Country:US
Mailing Address - Phone:907-246-3566
Mailing Address - Fax:
Practice Address - Street 1:6800 TERRY STREET
Practice Address - Street 2:
Practice Address - City:KING SALMON
Practice Address - State:AK
Practice Address - Zip Code:99613-0335
Practice Address - Country:US
Practice Address - Phone:907-246-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT7782Medicaid
AKPT7782Medicaid