Healthcare Provider Details

I. General information

NPI: 1922745405
Provider Name (Legal Business Name): JOHN ROBERT BRYANT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 FORT LOUDOUN MEDICAL CENTER DR STE 100
LENOIR CITY TN
37772-5676
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-4861
  • Fax: 865-988-8837
Mailing address:
  • Phone: 865-694-0062
  • Fax: 865-694-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14238
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: