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NPI Code Detail

MEDICARE: TRACY ANNE BRYAN-OLIVER P.T.

MEDICARE: TRACY ANNE BRYAN-OLIVER P.T.
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
1225100000XPhysical Therapist18675MD

General Provider Information

NPI Number : 1366635625
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY ANNE BRYAN-OLIVER P.T.
Provider Business Mailing Address
First Line : 7601 GREENSTABLE GATE LN
Second Line :
City : LAUREL
State : MD
Zip : 20707-9413
Country : US
Telephone Number : 301-328-1456
Fax Number :
Provider Business Practice Location Address
First Line : 4409 E WEST HWY
Second Line :
City : RIVERDALE
State : MD
Zip : 20737-1058
Country : US
Telephone Number : 301-985-3221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 08/18/2011

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