Provider Demographics
NPI:1508541525
Name:BRYANT, MONET STAR (CPS)
Entity type:Individual
Prefix:
First Name:MONET
Middle Name:STAR
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 SAINT CYR RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-1224
Mailing Address - Country:US
Mailing Address - Phone:314-861-8972
Mailing Address - Fax:
Practice Address - Street 1:13949 MANCHESTER RD # 4
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4505
Practice Address - Country:US
Practice Address - Phone:314-861-8972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier