Provider Demographics
NPI:1164659256
Name:LANCE, BRYAN W (DPT)
Entity Type:Individual
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First Name:BRYAN
Middle Name:W
Last Name:LANCE
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:24569 ROUTE 6
Mailing Address - Street 2:SUITE C
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8254
Mailing Address - Country:US
Mailing Address - Phone:570-265-1111
Mailing Address - Fax:570-265-7134
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:SUITE 210A
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-955-3380
Practice Address - Fax:570-342-0889
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2011-04-19
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Provider Licenses
StateLicense IDTaxonomies
PAPT019938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159221R9XMedicare PIN