Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1707 | IL |
NPI | 1649215781 |
---|---|
Provider Name | Bryan J Garrison |
First Address | Memphis, TN 38134-8156 |
Second Address | Memphis, TN 38104-2127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |