Provider Demographics
NPI:1275728115
Name:BRYANT, TERESSA
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-1612
Mailing Address - Country:US
Mailing Address - Phone:910-865-2700
Mailing Address - Fax:910-865-2800
Practice Address - Street 1:216 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1612
Practice Address - Country:US
Practice Address - Phone:910-865-2700
Practice Address - Fax:910-865-2800
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter