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General NPI Number Information
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NPI Number | 1972266161
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Entity Type | Organization
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Legal Business Name | BRYANT LIFE WELLNESS LLC
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 8316 229TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2155
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Country | US
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Telephone | 917-837-2452
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Fax |
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Provider Business Mailing Address
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Address Line | 8316 229TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2155
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Country | US
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Telephone | 917-837-2452
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MR. WALTER ALEXANDER BRYANT JR.
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Credential | OTR/L
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Telephone | 917-837-2452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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