Provider Demographics
NPI:1083215974
Name:BRYSON, JOHN GREGORY (CMT, LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GREGORY
Last Name:BRYSON
Suffix:
Gender:M
Credentials:CMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TRIANGLE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7701
Mailing Address - Country:US
Mailing Address - Phone:540-239-9959
Mailing Address - Fax:
Practice Address - Street 1:801 TRIANGLE ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7701
Practice Address - Country:US
Practice Address - Phone:540-239-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-581171100000X
VA0121000558171100000X
VA0019008393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist