Healthcare Provider Details

I. General information

NPI: 1871315317
Provider Name (Legal Business Name): BRYCE WILLIAM HANMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 HEYWARD ST
COLUMBIA SC
29208-3407
US

IV. Provider business mailing address

1 CATAWBA CIR APT 110
COLUMBIA SC
29201-5266
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-4202
  • Fax:
Mailing address:
  • Phone: 920-784-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: