Provider Demographics
NPI:1376717819
Name:SOWELL, BRYAN K (PT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:SOWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MALL BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4801
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:16915 HIGHWAY 67
Practice Address - Street 2:SUITE A
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5819
Practice Address - Country:US
Practice Address - Phone:912-681-2500
Practice Address - Fax:912-681-2025
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist