Healthcare Provider Details

I. General information

NPI: 1235411521
Provider Name (Legal Business Name): ANGELA P BRYANT CFTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 3RD ST
PEMBROKE NC
28372-8768
US

IV. Provider business mailing address

124 NESTLE LN
LUMBERTON NC
28360-0563
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-0009
  • Fax: 910-521-5654
Mailing address:
  • Phone: 910-887-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFTS1147
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: