Provider Demographics
NPI:1093388357
Name:RYAN, BRIANA LYNN (LMT)
Entity Type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:LYNN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RYT 200
Mailing Address - Street 1:4635 BURLINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8131
Mailing Address - Country:US
Mailing Address - Phone:727-831-7926
Mailing Address - Fax:
Practice Address - Street 1:4635 BURLINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8131
Practice Address - Country:US
Practice Address - Phone:727-831-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist