Healthcare Provider Details

I. General information

NPI: 1831619402
Provider Name (Legal Business Name): DEBORAH BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 BLUE JAY DR
LIBERTY MO
64068-1977
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-2315
  • Fax: 816-407-1555
Mailing address:
  • Phone: 816-407-4555
  • Fax: 816-781-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2014038546
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: