Provider Demographics
NPI:1255678363
Name:CIANCIO, BRYCE ANDREW (ATC/L)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:ANDREW
Last Name:CIANCIO
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-4773
Mailing Address - Country:US
Mailing Address - Phone:334-707-3286
Mailing Address - Fax:
Practice Address - Street 1:2400 DOBBS DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-2305
Practice Address - Country:US
Practice Address - Phone:334-298-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer