Provider Demographics
NPI:1427593219
Name:EARDLEY-PRYOR, BRIANNA (LOM)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:EARDLEY-PRYOR
Suffix:
Gender:F
Credentials:LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 POPLAR ST
Mailing Address - Street 2:#2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1426
Mailing Address - Country:US
Mailing Address - Phone:831-869-8925
Mailing Address - Fax:
Practice Address - Street 1:519 S 9TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1331
Practice Address - Country:US
Practice Address - Phone:267-293-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist