Provider Demographics
NPI:1134207814
Name:BRYANT, MARY JO (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 COUNTRY VIEW
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-683-5717
Mailing Address - Fax:
Practice Address - Street 1:9469 KENWOOD ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-745-9877
Practice Address - Fax:513-745-0966
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 01074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214940Medicaid
OH366632Medicare ID - Type Unspecified