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General NPI Number Information
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NPI Number | 1861124158
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Entity Type | Individual
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Provider Name | COREY ANDREW BRYAN
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 21475 RIDGETOP CIR STE 260
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City | STERLING
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State | VA
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Zip | 20166-8580
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Country | US
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Telephone | 703-433-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 5605 BLOOMINGDALE AVE
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City | HENRICO
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State | VA
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Zip | 23228-5710
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Country | US
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Telephone | 703-944-4094
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305215130
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License Number State | VA
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