Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2148109 | TX |
NPI | 1013563931 |
---|---|
Provider Name | Tiffany Bryson |
First Address | Duncanville, TX 75116-2828 |
Second Address | Duncanville, TX 75116-2828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2019 |
Last Update Date | 24/06/2021 |