Provider Demographics
NPI:1437151941
Name:BRYANT, WAYNE D (PT)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:D
Last Name:BRYANT
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 1:215 PROSPECT CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1646
Mailing Address - Country:US
Mailing Address - Phone:717-235-0317
Mailing Address - Fax:
Practice Address - Street 1:7672 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-663-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016746225100000X
MD14225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2000800OtherKEYSTONE
PA3768917OtherAETNA
PA50311OtherALLIANCE
PABR871049OtherHIGHMARK
PA50038563OtherCBC
MD0006OtherCAREFIRST
MD411453-13OtherCAREFIRST
PA5562481OtherAETNA
PA5562481OtherAETNA