Provider Demographics
NPI:1730389818
Name:BRYANT, TERESA DAWN (PT)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:DAWN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7083 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1241
Mailing Address - Country:US
Mailing Address - Phone:520-258-0666
Mailing Address - Fax:520-258-0689
Practice Address - Street 1:7083 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1241
Practice Address - Country:US
Practice Address - Phone:520-258-0666
Practice Address - Fax:520-258-0689
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist