Provider Demographics
NPI:1497849095
Name:BRYAN, TARA L (RPT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:BRYAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 SW WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-4030
Mailing Address - Country:US
Mailing Address - Phone:785-271-6700
Mailing Address - Fax:
Practice Address - Street 1:1570 SW WESTPORT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4030
Practice Address - Country:US
Practice Address - Phone:785-271-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200277920AMedicaid
KS140792OtherBLUE CROSS BLUE SHIELD
KS646300OtherFIRST GUARD GROUP NUMBER