Provider Demographics
NPI:1982765814
Name:BRYANT, LENORE ANN (MPT)
Entity type:Individual
Prefix:
First Name:LENORE
Middle Name:ANN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 NORTH 1ST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-256-0868
Mailing Address - Fax:970-255-0469
Practice Address - Street 1:1119 NORTH 1ST ST
Practice Address - Street 2:SUITE J
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-256-0868
Practice Address - Fax:970-255-0469
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1982765814Medicare PIN