MEDICARE: MR. BRYAN FEDERICO DOCTOR OF PHYSICAL T

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	05146R	LA
2	225100000X	Physical Therapist	8823	NC
3	225100000X	Physical Therapist	12513	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05146R	OTHER	LA	PHYSICAL THERAPY LICENSE
2	0000012513	OTHER	TN	LICENSE

General Provider Information

NPI Number	:	1689741639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN FEDERICO DOCTOR OF PHYSICAL T

Provider Business Mailing Address
First Line	:	907 BUFFALO ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6719
Country	:	US
Telephone Number	:	423-430-6611
Fax Number	:	423-815-1051

Provider Business Practice Location Address
First Line	:	907 BUFFALO ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6719
Country	:	US
Telephone Number	:	423-430-6611
Fax Number	:	423-815-1051

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	12/02/2025

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Directions to “ MR. BRYAN FEDERICO DOCTOR OF PHYSICAL T” Practice Location

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