Provider Demographics
NPI:1326711649
Name:BRYAN, MARITZA
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:BRYAN
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 1:1403 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-7110
Mailing Address - Country:US
Mailing Address - Phone:407-504-0321
Mailing Address - Fax:
Practice Address - Street 1:1403 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-7110
Practice Address - Country:US
Practice Address - Phone:407-504-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2022-09-16
Deactivation Date:2021-12-21
Deactivation Code:
Reactivation Date:2022-09-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist