Provider Demographics
NPI:1851335244
Name:BRYANT, JANICE SHOPLAND (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:SHOPLAND
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 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:150 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2026
Practice Address - Country:US
Practice Address - Phone:860-456-2232
Practice Address - Fax:860-456-2256
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080001562OtherANTHEM BC
CT2V8093OtherHEALTHNET
CT004139300Medicaid
CT650000784Medicare PIN