Healthcare Provider Details

I. General information

NPI: 1104789544
Provider Name (Legal Business Name): CHARLOTTE BRYAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 RENAISSANCE COMMONS BLVD APT 522
BOYNTON BEACH FL
33426-8288
US

IV. Provider business mailing address

1605 RENAISSANCE COMMONS BLVD APT 522
BOYNTON BEACH FL
33426-8288
US

V. Phone/Fax

Practice location:
  • Phone: 561-350-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: