Provider Demographics
NPI:1801769203
Name:CLOUD, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CLOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19907 QUAIL PINE LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2286
Mailing Address - Country:US
Mailing Address - Phone:541-419-4538
Mailing Address - Fax:
Practice Address - Street 1:19907 QUAIL PINE LOOP
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2286
Practice Address - Country:US
Practice Address - Phone:541-419-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-24357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist