Provider Demographics
NPI:1952059529
Name:BRYANT, MATTHEW NICHOLAS (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:NICHOLAS
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 1:13951 W GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2436
Mailing Address - Country:US
Mailing Address - Phone:623-537-9730
Mailing Address - Fax:
Practice Address - Street 1:13951 W GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2436
Practice Address - Country:US
Practice Address - Phone:623-537-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist