Provider Demographics
NPI:1689263170
Name:THOMAS, BRYAN TAYLOR (PT)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:TAYLOR
Last Name:THOMAS
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 BOREN AVE STE 410
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3548
Practice Address - Country:US
Practice Address - Phone:206-447-1570
Practice Address - Fax:206-447-1592
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61141376225100000X
SC10408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10408OtherSOUTH CAROLINA LABOR LICENSING REGULATION