Provider Demographics
NPI:1255374096
Name:GAUNT, BRYCE WILLARD (PT, SCS)
Entity type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:WILLARD
Last Name:GAUNT
Suffix:
Gender:M
Credentials:PT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 LEE ROAD 288
Mailing Address - Street 2:
Mailing Address - City:SMITHS
Mailing Address - State:AL
Mailing Address - Zip Code:36877-2670
Mailing Address - Country:US
Mailing Address - Phone:334-297-9690
Mailing Address - Fax:
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:SUITE 101B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-256-0825
Practice Address - Fax:706-256-0830
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3680OtherGEORGIA STATE LICENSE