Provider Demographics
NPI:1104367929
Name:BRYANT, ROXANNE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:TIMPKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:20098 ASHBROOK PL
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3394
Mailing Address - Country:US
Mailing Address - Phone:703-723-5225
Mailing Address - Fax:703-723-5595
Practice Address - Street 1:20098 ASHBROOK PL
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3393
Practice Address - Country:US
Practice Address - Phone:703-723-5225
Practice Address - Fax:703-723-5595
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist