Provider Demographics
NPI:1558857201
Name:ENSOR, BRYCE ANDREW (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:ANDREW
Last Name:ENSOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24985 MONROE ROAD 217
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAY
Mailing Address - State:MO
Mailing Address - Zip Code:65258-2202
Mailing Address - Country:US
Mailing Address - Phone:573-473-0179
Mailing Address - Fax:
Practice Address - Street 1:400 E UNIVERSITY WAY
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-7500
Practice Address - Country:US
Practice Address - Phone:509-963-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer