Provider Demographics
NPI:1023382991
Name:ANDERSON, BRYAN TAYLOR
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:TAYLOR
Last Name:ANDERSON
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 1:195 N BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2720
Mailing Address - Country:US
Mailing Address - Phone:775-867-3049
Mailing Address - Fax:
Practice Address - Street 1:195 N BAILEY ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2720
Practice Address - Country:US
Practice Address - Phone:775-867-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner