Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1275728115 |
---|---|
Provider Name | Teressa Bryant |
First Address | Saint Pauls, NC 28384-1612 |
Second Address | Saint Pauls, NC 28384-1612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 13/09/2007 |