Provider Demographics
NPI:1669755252
Name:ALLRED, BRIAN C (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:ALLRED
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 1:727 E BRUNDAGE LN STE L
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6280
Mailing Address - Country:US
Mailing Address - Phone:307-683-0123
Mailing Address - Fax:307-683-0101
Practice Address - Street 1:727 E BRUNDAGE LN STE L
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6280
Practice Address - Country:US
Practice Address - Phone:307-683-0123
Practice Address - Fax:307-683-0101
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY132076900Medicaid
W28205Medicare UPIN