Provider Demographics
NPI:1457665895
Name:EPPERLY, BRYAN SHANE (LMTI, CMT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SHANE
Last Name:EPPERLY
Suffix:
Gender:M
Credentials:LMTI, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 BARTON SPRINGS RD
Mailing Address - Street 2:#49
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8880
Mailing Address - Country:US
Mailing Address - Phone:512-809-6708
Mailing Address - Fax:
Practice Address - Street 1:1902-D SOUTH CONGRESS AVE.
Practice Address - Street 2:SUITE #4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-809-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100088172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist