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General NPI Number Information
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NPI Number | 1104072008
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Entity Type | Organization
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Legal Business Name | BRYANT THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 201 W 7TH ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-1935
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Country | US
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Telephone | 601-408-1003
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Fax | 601-582-4258
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Provider Business Mailing Address
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Address Line | 201 W 7TH ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-1935
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Country | US
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Telephone | 601-408-1003
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Fax | 601-582-4258
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Authorized Official
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Title or Position | SLP / OWNER
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Name | MRS. TANYA W BRYANT
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Credential | CCC
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Telephone | 601-408-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S2491
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License Number State | MS
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