Provider Demographics
NPI:1588296560
Name:SUMNER, BRYAN SCOTT (DPT)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SCOTT
Last Name:SUMNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 NW 86TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1738
Mailing Address - Country:US
Mailing Address - Phone:515-418-7629
Mailing Address - Fax:
Practice Address - Street 1:5627 NW 86TH ST STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1738
Practice Address - Country:US
Practice Address - Phone:515-270-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist