Provider Demographics
NPI:1982332128
Name:BRYAN, THOMAS CLAYTON (PT)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CLAYTON
Last Name:BRYAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 FOREST DR STE B101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4146
Mailing Address - Country:US
Mailing Address - Phone:803-764-2362
Mailing Address - Fax:
Practice Address - Street 1:3800 FOREST DR STE B101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4146
Practice Address - Country:US
Practice Address - Phone:803-764-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist