Provider Demographics
NPI:1861176083
Name:FORSYTH, BRIANNA N
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:N
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 STATE ROAD 230 E
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-7152
Mailing Address - Country:US
Mailing Address - Phone:316-390-9674
Mailing Address - Fax:
Practice Address - Street 1:1954 STATE ROAD 230 E
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-7152
Practice Address - Country:US
Practice Address - Phone:316-390-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31392225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant