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General NPI Number Information
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NPI Number | 1720467004
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Entity Type | Organization
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Legal Business Name | BRYAN FALLIS
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 1210 KY HIGHWAY 36 E
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City | CYNTHIANA
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State | KY
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Zip | 41031-7498
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Country | US
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Telephone | 859-341-2440
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Fax | 859-341-2449
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Provider Business Mailing Address
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Address Line | 1210 KY HIGHWAY 36 E
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City | CYNTHIANA
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State | KY
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Zip | 41031-7498
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Country | US
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Telephone | 859-341-2440
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Fax | 859-341-2449
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Authorized Official
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Title or Position | DPM/OWNER
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Name | BRYAN FALLIS
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Credential | DPM
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Telephone | 859-341-2440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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