Provider Demographics
NPI:1760549620
Name:BRYANT, LORI ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:BRYANT
Suffix:
Gender:F
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:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:
Practice Address - Street 1:2424 N WYATT DR
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6115
Practice Address - Country:US
Practice Address - Phone:520-784-6570
Practice Address - Fax:520-784-6574
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1972225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151936Medicaid
AZZ112500Medicare PIN