Provider Demographics
NPI:1245352376
Name:BRYANT, AMMIE LYNN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:AMMIE
Middle Name:LYNN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 HOLLYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-5001
Mailing Address - Country:US
Mailing Address - Phone:352-223-4946
Mailing Address - Fax:
Practice Address - Street 1:5827 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-1763
Practice Address - Country:US
Practice Address - Phone:850-983-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist