MEDICARE: MR. ERIC LOUIS BRYANT LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2680	NC

General Provider Information

NPI Number	:	1164799011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC LOUIS BRYANT LPTA

Provider Business Mailing Address
First Line	:	7208 ROCKLEDGE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6515
Country	:	US
Telephone Number	:	704-556-9643
Fax Number	:

Provider Business Practice Location Address
First Line	:	7208 ROCKLEDGE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6515
Country	:	US
Telephone Number	:	704-556-9643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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