Provider Demographics
NPI:1992467351
Name:HART, BRYAN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 N ARMENIA AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1436
Mailing Address - Country:US
Mailing Address - Phone:813-442-6015
Mailing Address - Fax:
Practice Address - Street 1:4809 N ARMENIA AVE STE 230
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1436
Practice Address - Country:US
Practice Address - Phone:813-442-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer