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General NPI Number Information
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NPI Number | 1053473710
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Entity Type | Individual
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Provider Name | TIFFANY A BRYAN DPT
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 3411 UNIVERSITY AVE STE 1
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City | MORGANTOWN
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State | WV
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Zip | 26505-7219
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Country | US
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Telephone | 304-598-3221
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Fax |
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Provider Business Mailing Address
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Address Line | 11129 GOLDEN SILENCE DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-2344
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Country | US
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Telephone | 304-543-0534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | WV002345
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28975
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License Number State | FL
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