Provider Demographics
NPI:1164799011
Name:BRYANT, ERIC LOUIS (LPTA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LOUIS
Last Name:BRYANT
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6515
Mailing Address - Country:US
Mailing Address - Phone:704-556-9643
Mailing Address - Fax:
Practice Address - Street 1:7208 ROCKLEDGE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6515
Practice Address - Country:US
Practice Address - Phone:704-556-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2680225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant