MEDICARE: ALEX BRYANT

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	2251X0800X	Orthopedic Physical Therapist	011163	GA

General Provider Information

NPI Number	:	1780073684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX BRYANT

Provider Business Mailing Address
First Line	:	150 RED OAK CT
Second Line	:
City	:	PINE MOUNTAIN
State	:	GA
Zip	:	31822-3645
Country	:	US
Telephone Number	:	706-325-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 RED OAK CT
Second Line	:
City	:	PINE MOUNTAIN
State	:	GA
Zip	:	31822-3645
Country	:	US
Telephone Number	:	706-325-6971
Fax Number	:

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

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “ ALEX BRYANT ” Practice Location

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