Provider Demographics
NPI:1891039160
Name:BRYANT, VERNON THOMAS JR (RKT)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:THOMAS
Last Name:BRYANT
Suffix:JR
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 CYRUS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6423
Mailing Address - Country:US
Mailing Address - Phone:919-866-9951
Mailing Address - Fax:
Practice Address - Street 1:3714 CYRUS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6423
Practice Address - Country:US
Practice Address - Phone:919-866-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1848226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist