Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1848 | NC |
NPI | 1891039160 |
---|---|
Provider Name | Vernon Thomas Bryant JR. |
First Address | Raleigh, NC 27610-6423 |
Second Address | Raleigh, NC 27610-6423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |