Provider Demographics
NPI:1710396874
Name:CREIDLER, BRYAN
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CREIDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N CHURCH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5666
Mailing Address - Country:US
Mailing Address - Phone:336-274-7480
Mailing Address - Fax:336-274-8903
Practice Address - Street 1:1051 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4267
Practice Address - Country:US
Practice Address - Phone:919-363-3640
Practice Address - Fax:919-363-3642
Is Sole Proprietor?:No
Enumeration Date:2014-08-03
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist