Provider Demographics
NPI:1538103536
Name:BRYANT, MICHAEL SHANE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHANE
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:M
Other - Middle Name:SHANE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 426C
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:303-221-5757
Mailing Address - Fax:303-221-5759
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 426C
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-221-5757
Practice Address - Fax:303-221-5759
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist