Healthcare Provider Details

I. General information

NPI: 1467124578
Provider Name (Legal Business Name): JEREMY BRYAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 HOME AVE
DARLINGTON SC
29532-7625
US

IV. Provider business mailing address

10133 SHERRILL BLVD STE 200
KNOXVILLE TN
37932-3347
US

V. Phone/Fax

Practice location:
  • Phone: 843-393-2867
  • Fax:
Mailing address:
  • Phone: 865-531-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37509
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215729
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23138
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017480
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH11808
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberT-W0049-3
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT032334
License Number StatePA
# 8
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11400
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: