Healthcare Provider Details

I. General information

NPI: 1700738176
Provider Name (Legal Business Name): MARY ANNE BRYAN LMT, MMT, NCTMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 GRETNA RD
BRANSON MO
65616-7202
US

IV. Provider business mailing address

4470 GRETNA RD
BRANSON MO
65616-7202
US

V. Phone/Fax

Practice location:
  • Phone: 417-320-3413
  • Fax: 417-320-3415
Mailing address:
  • Phone: 417-320-3413
  • Fax: 417-320-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2023032824
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: