Provider Demographics
NPI:1699719856
Name:PAINTER, BRYAN JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JAMES
Last Name:PAINTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 27TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-9592
Mailing Address - Country:US
Mailing Address - Phone:541-791-9281
Mailing Address - Fax:
Practice Address - Street 1:1400 NW BUCHANAN AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5838
Practice Address - Country:US
Practice Address - Phone:541-757-4455
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-317841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist