Provider Demographics
NPI:1871847806
Name:BRYANT, DARA (LMT)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8534 SE MILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1439
Mailing Address - Country:US
Mailing Address - Phone:740-707-8381
Mailing Address - Fax:
Practice Address - Street 1:7831 SE STARK ST
Practice Address - Street 2:STE. 208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2357
Practice Address - Country:US
Practice Address - Phone:740-707-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18267172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist