Provider Demographics
NPI:1508094939
Name:BRYANT, FELICIA DAWN (LMT)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:DAWN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1705 E HIGHWAY 50
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5186
Mailing Address - Country:US
Mailing Address - Phone:352-394-7577
Mailing Address - Fax:352-394-8000
Practice Address - Street 1:1705 E HIGHWAY 50
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5186
Practice Address - Country:US
Practice Address - Phone:352-394-7577
Practice Address - Fax:352-394-8000
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist