MEDICARE: MR. BRYON JAMES MCALLISTER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227800000X	Certified Respiratory Therapist	000242-0	NY

General Provider Information

NPI Number	:	1063474294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYON JAMES MCALLISTER ATC

Provider Business Mailing Address
First Line	:	8754 SIENNA DR
Second Line	:
City	:	CICERO
State	:	NY
Zip	:	13039-7898
Country	:	US
Telephone Number	:	315-699-1742
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 LIBERTY ST
Second Line	:	CAZENOVIA COLLEGE ATHLETIC CENTER
City	:	CAZENOVIA
State	:	NY
Zip	:	13035-1008
Country	:	US
Telephone Number	:	315-655-7321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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