Provider Demographics
NPI:1942904883
Name:BRYANT, THOMAS (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 STATE FARM RD STE D
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4996
Mailing Address - Country:US
Mailing Address - Phone:828-773-3502
Mailing Address - Fax:
Practice Address - Street 1:820 STATE FARM RD STE D
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4996
Practice Address - Country:US
Practice Address - Phone:828-773-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC961237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty