Provider Demographics
NPI:1013056274
Name:BRYANT, LORI BETH (RD, LD, CPT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RD, LD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 SHASTA LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7179
Mailing Address - Country:US
Mailing Address - Phone:972-874-3632
Mailing Address - Fax:214-596-9315
Practice Address - Street 1:4324 N BELT LINE RD
Practice Address - Street 2:SUITE C204
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3501
Practice Address - Country:US
Practice Address - Phone:214-596-9302
Practice Address - Fax:214-596-9315
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05802133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered