Healthcare Provider Details

I. General information

NPI: 1851207658
Provider Name (Legal Business Name): ALLEN BRYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL LN STE B
ENTERPRISE AL
36330-2392
US

IV. Provider business mailing address

100 PROFESSIONAL LN STE B
ENTERPRISE AL
36330-2392
US

V. Phone/Fax

Practice location:
  • Phone: 334-393-7500
  • Fax: 334-393-7505
Mailing address:
  • Phone: 334-393-7500
  • Fax: 334-393-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: