Provider Demographics
NPI:1598252827
Name:BRYANT, LAUREL A (LMT, CPMT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMT, CPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SPRING ST APT 321
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4008
Mailing Address - Country:US
Mailing Address - Phone:718-757-4113
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-920-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05912225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist