Provider Demographics
NPI:1265218408
Name:BRYANT, ALLY (DPT)
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CEDAR PARK BLVD APT 327
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7135
Mailing Address - Country:US
Mailing Address - Phone:908-329-4702
Mailing Address - Fax:
Practice Address - Street 1:201 SAINT JOSEPH CT STE 310
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-3404
Practice Address - Country:US
Practice Address - Phone:737-843-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031449225100000X
TX1384068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist