MEDICARE: MR. COURTNEY E BRYAN JR. LMT

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	225700000X	Massage Therapist	MA60539016	WA

General Provider Information

NPI Number	:	1982122834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COURTNEY E BRYAN JR. LMT

Provider Business Mailing Address
First Line	:	1900 8TH AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2711
Country	:	US
Telephone Number	:	360-451-3098
Fax Number	:

Provider Business Practice Location Address
First Line	:	3302 FUHRMAN AVE E STE 110
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-7115
Country	:	US
Telephone Number	:	206-402-4012
Fax Number	:

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	08/30/2017

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