Provider Demographics
NPI:1205199544
Name:BRYAN, ANNE LORENE (MS, ATC, LAT, CES)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LORENE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BEAMER WAY 150 JAMERSON ATHLETIC CENTER
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-0001
Mailing Address - Country:US
Mailing Address - Phone:540-231-2711
Mailing Address - Fax:
Practice Address - Street 1:21 BEAMER WAY 150 JAMERSON ATHLETIC CENTER
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-1024
Practice Address - Country:US
Practice Address - Phone:540-231-2711
Practice Address - Fax:540-231-7335
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT001815174400000X
VA0126002257174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist