MEDICARE: BRYAN JAMES PARSHALL 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	5501016032	MI

General Provider Information

NPI Number	:	1770831661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN JAMES PARSHALL DPT

Provider Business Mailing Address
First Line	:	8872 PROFESSIONAL DR STE C
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-8482
Country	:	US
Telephone Number	:	231-876-0010
Fax Number	:	231-876-1246

Provider Business Practice Location Address
First Line	:	1363 DOUGLAS DR
Second Line	:	SUITE 104 B
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8980
Country	:	US
Telephone Number	:	231-876-0010
Fax Number	:	231-876-1246

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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