MEDICARE: TINA BRYANT PT

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	225100000X	Physical Therapist	002042	KY

General Provider Information

NPI Number	:	1073777256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA BRYANT PT

Provider Business Mailing Address
First Line	:	410 FALCON CRST
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047-7818
Country	:	US
Telephone Number	:	502-551-7645
Fax Number	:	502-538-9254

Provider Business Practice Location Address
First Line	:	410 FALCON CRST
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-7818
Country	:	US
Telephone Number	:	502-551-7645
Fax Number	:	502-538-9254

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	01/13/2020

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Directions to “ TINA BRYANT PT” Practice Location

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