Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2007004682 | MO |
NPI | 1003053877 |
---|---|
Provider Name | Mr. Donald N Bryant |
First Address | Springfield, MO 65804-4723 |
Second Address | Springfield, MO 65802-5500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 25/01/2011 |