MEDICARE: BRYAN HART MS, ATC

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	2255A2300X	Athletic Trainer	5935	FL

General Provider Information

NPI Number	:	1992467351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN HART MS, ATC

Provider Business Mailing Address
First Line	:	4809 N ARMENIA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1436
Country	:	US
Telephone Number	:	813-442-6015
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 N ARMENIA AVE STE 230
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1436
Country	:	US
Telephone Number	:	813-442-6015
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	10/12/2021

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