Provider Demographics
NPI:1255805842
Name:DEWAR, BRYAN S (LMT)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:S
Last Name:DEWAR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MONTEBELLO RD APT 116C
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1383
Mailing Address - Country:US
Mailing Address - Phone:719-696-1893
Mailing Address - Fax:
Practice Address - Street 1:44 MONTEBELLO RD APT 116C
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1383
Practice Address - Country:US
Practice Address - Phone:719-696-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist