Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | PT017879 | OH |
NPI | 1174089916 |
---|---|
Provider Name | Spencer Bryant |
First Address | Sandusky, OH 44870-7361 |
Second Address | Sandusky, OH 44870-7033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 18/02/2019 |