Provider Demographics
NPI:1831790039
Name:BRAMMER, BRYANA (PT)
Entity type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:BRAMMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRYANA
Other - Middle Name:
Other - Last Name:GREENHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:144 S CAROL MALONE BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1352
Mailing Address - Country:US
Mailing Address - Phone:606-474-7649
Mailing Address - Fax:
Practice Address - Street 1:144 S CAROL MALONE BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1352
Practice Address - Country:US
Practice Address - Phone:606-474-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY008113OtherPHYSICAL THERAPIST LICENSE