Provider Demographics
NPI:1245679281
Name:PRESS, BRYAN SAMUEL VINSON (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:SAMUEL VINSON
Last Name:PRESS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:3100 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4706
Practice Address - Country:US
Practice Address - Phone:804-342-5857
Practice Address - Fax:804-355-0408
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24512225100000X
VA2305207948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherMEDICARE GROUP PTAN
VA1245679281OtherMEDICAID QMB PROVIDER ID
VAQ52452AMedicare PIN