MEDICARE: EMMA BRYAN

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1437904398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA BRYAN

Provider Business Mailing Address
First Line	:	2030 WILDTS BATTERY BLVD APT 1038
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8271
Country	:	US
Telephone Number	:	412-716-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3226 MAYBANK HWY STE C
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4860
Country	:	US
Telephone Number	:	412-716-2500
Fax Number	:

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

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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Directions to “ EMMA BRYAN ” Practice Location

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