Provider Demographics
NPI:1740940204
Name:WEATHERS, BRYON
Entity type:Individual
Prefix:MR
First Name:BRYON
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 CHESAPEAKE ST SE APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3414
Mailing Address - Country:US
Mailing Address - Phone:202-746-9966
Mailing Address - Fax:
Practice Address - Street 1:808 CHESAPEAKE ST SE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3414
Practice Address - Country:US
Practice Address - Phone:202-746-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant