Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023382991 |
---|---|
Provider Name | Mr. Bryan Taylor Anderson |
First Address | Fallon, NV 89406-2720 |
Second Address | Fallon, NV 89406-2720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2012 |
Last Update Date | 23/02/2012 |