Provider Demographics
NPI:1497849095
Name:BRYAN, TARA L (RPT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:BRYAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 SW WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-4030
Mailing Address - Country:US
Mailing Address - Phone:785-271-6700
Mailing Address - Fax:
Practice Address - Street 1:1570 SW WESTPORT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4030
Practice Address - Country:US
Practice Address - Phone:785-271-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS646300OtherFIRST GUARD GROUP NUMBER
KS140792OtherBLUE CROSS BLUE SHIELD
KS646300OtherFIRST GUARD GROUP NUMBER