Provider Demographics
NPI:1558447441
Name:BIRD, BRYAN (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:BIRD
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 1:1189 E HERNDON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3167
Mailing Address - Country:US
Mailing Address - Phone:559-436-8525
Mailing Address - Fax:
Practice Address - Street 1:1189 E HERNDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3167
Practice Address - Country:US
Practice Address - Phone:559-436-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT107270Medicare ID - Type UnspecifiedPHYSICAL THERAPY