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General NPI Number Information
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NPI Number | 1093013955
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Entity Type | Individual
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Provider Name | TOMAS FERDINAND BRYANT PT
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Gender | Male
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 301 W FERTITTA BLVD STE 4
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City | LEESVILLE
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State | LA
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Zip | 71446-4666
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Country | US
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Telephone | 337-238-9931
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Fax | 337-239-0066
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Provider Business Mailing Address
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Address Line | 301 W FERTITTA BLVD STE 4
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City | LEESVILLE
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State | LA
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Zip | 71446-4666
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Country | US
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Telephone | 337-238-9931
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Fax | 337-239-0066
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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 | 07511
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License Number State | LA
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