MEDICARE: BRYANT BELNAP PT

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	PT-343	ID

General Provider Information

NPI Number	:	1619917200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYANT BELNAP PT

Provider Business Mailing Address
First Line	:	3345 MERLIN DR
Second Line	:	SUITE 100
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-522-4481
Fax Number	:	208-522-6137

Provider Business Practice Location Address
First Line	:	3345 MERLIN DR
Second Line	:	SUITE 100
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-522-4481
Fax Number	:	208-522-6137

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/09/2008

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Directions to “ BRYANT BELNAP PT” Practice Location

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