Healthcare Provider Details

I. General information

NPI: 1972944122
Provider Name (Legal Business Name): BRYAN JOSEPH LADISLAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 JOHN HAWKINS PKWY
HOOVER AL
35244-1095
US

IV. Provider business mailing address

2949 JOHN HAWKINS PKWY
HOOVER AL
35244-1095
US

V. Phone/Fax

Practice location:
  • Phone: 205-396-1530
  • Fax: 205-396-1535
Mailing address:
  • Phone: 205-396-1530
  • Fax: 205-396-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH7643
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPTL.0011451
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: