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General NPI Number Information
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NPI Number | 1205199544
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Entity Type | Individual
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Provider Name | ANNE LORENE BRYAN M.S., ATC, LAT, CES
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 12/18/2022
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Provider Practice Location Address
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Address Line | 21 BEAMER WAY 150 JAMERSON ATHLETIC CENTER
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City | BLACKSBURG
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State | VA
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Zip | 24061-1024
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Country | US
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Telephone | 540-231-2711
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Fax | 540-231-7335
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Provider Business Mailing Address
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Address Line | 21 BEAMER WAY 150 JAMERSON ATHLETIC CENTER
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City | BLACKSBURG
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State | VA
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Zip | 24061-0001
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Country | US
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Telephone | 540-231-2711
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT001815
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0126002257
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License Number State | VA
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