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NPI Code Detail

MEDICARE: BRYAN JOSEPH LADISLAS DPT

MEDICARE: BRYAN JOSEPH LADISLAS 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
1171000000XMilitary Health Care ProviderPTL.0011451CO
2225100000XPhysical TherapistPTH7643AL

General Provider Information

NPI Number : 1972944122
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN JOSEPH LADISLAS DPT
Provider Business Mailing Address
First Line : 2949 JOHN HAWKINS PKWY
Second Line :
City : HOOVER
State : AL
Zip : 35244-1095
Country : US
Telephone Number : 205-396-1530
Fax Number : 205-396-1535
Provider Business Practice Location Address
First Line : 2949 JOHN HAWKINS PKWY
Second Line :
City : HOOVER
State : AL
Zip : 35244-1095
Country : US
Telephone Number : 205-396-1530
Fax Number : 205-396-1535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2013
Last Update Date : 09/29/2015

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Directions to “ BRYAN JOSEPH LADISLAS DPT” Practice Location

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