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NPI Code Detail

MEDICARE: CHRISTIN KELLEY BRYSON PT, DPT, LAT, ATC

MEDICARE: CHRISTIN KELLEY BRYSON PT, DPT, LAT, ATC
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
12255A2300XAthletic TrainerAT0000001781TN
2225100000XPhysical TherapistPT0000010768TN

General Provider Information

NPI Number : 1598263576
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIN KELLEY BRYSON PT, DPT, LAT, ATC
Provider Business Mailing Address
First Line : 308 LAKE DR
Second Line :
City : SOMERVILLE
State : TN
Zip : 38068-9716
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 308 LAKE DR
Second Line :
City : SOMERVILLE
State : TN
Zip : 38068-9716
Country : US
Telephone Number : 901-465-9861
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2018
Last Update Date : 01/25/2018

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