Healthcare Provider Details

I. General information

NPI: 1225964356
Provider Name (Legal Business Name): PHILIP TODD BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MARION ST
PILOT MOUNTAIN NC
27041-8671
US

IV. Provider business mailing address

1870 OSCAR FRYE RD
PINNACLE NC
27043-8269
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-4145
  • Fax:
Mailing address:
  • Phone: 336-448-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: