Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2544 | TN |
Y | 213ES0000X | Sports Medicine | 2544 | TN |
NPI | 1326616848 |
---|---|
Provider Name | Bryanna Renee Moltz |
First Address | Memphis, TN 38134-6559 |
Second Address | Memphis, TN 38104-5568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | (05) | AR |