Provider Demographics
NPI:1093013955
Name:BRYANT, TOMAS FERDINAND (PT)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:FERDINAND
Last Name:BRYANT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W FERTITTA BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4666
Mailing Address - Country:US
Mailing Address - Phone:337-238-9931
Mailing Address - Fax:337-239-0066
Practice Address - Street 1:301 W FERTITTA BLVD
Practice Address - Street 2:STE 4
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4666
Practice Address - Country:US
Practice Address - Phone:337-238-9931
Practice Address - Fax:337-239-0066
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07511OtherLA LICENSE