MEDICARE: ALLY BRYANT DPT

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	225100000X	Physical Therapist	PT031449	PA
2	225100000X	Physical Therapist	1384068	TX

General Provider Information

NPI Number	:	1265218408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLY BRYANT DPT

Provider Business Mailing Address
First Line	:	225 CEDAR PARK BLVD APT 327
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18042-7135
Country	:	US
Telephone Number	:	908-329-4702
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SAINT JOSEPH CT STE 310
Second Line	:
City	:	LIBERTY HILL
State	:	TX
Zip	:	78642-3404
Country	:	US
Telephone Number	:	737-843-4195
Fax Number	:

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

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	01/26/2024

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Directions to “ ALLY BRYANT DPT” Practice Location

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