Provider Demographics
NPI:1851489371
Name:BRYANT, JERRY L (PT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:BRYANT
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 1:116 W LIMA ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3032
Mailing Address - Country:US
Mailing Address - Phone:419-425-9798
Mailing Address - Fax:419-425-9698
Practice Address - Street 1:116 W LIMA ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3032
Practice Address - Country:US
Practice Address - Phone:419-425-9798
Practice Address - Fax:419-425-9698
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0563442Medicare PIN