Healthcare Provider Details

I. General information

NPI: 1629983515
Provider Name (Legal Business Name): ZACH BRYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E PIGEON PLUM DR APT 104
JUPITER FL
33458-4830
US

IV. Provider business mailing address

111 E PIGEON PLUM DR APT 104
JUPITER FL
33458-4830
US

V. Phone/Fax

Practice location:
  • Phone: 215-681-1042
  • Fax:
Mailing address:
  • Phone: 215-681-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License NumberLMY8271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: