Provider Demographics
NPI:1982883724
Name:ALBRIGHT, BRYAN (PT,)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ALBRIGHT
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 1:507 HUCK FINN SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2295
Mailing Address - Country:US
Mailing Address - Phone:573-795-4604
Mailing Address - Fax:
Practice Address - Street 1:507 HUCK FINN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2295
Practice Address - Country:US
Practice Address - Phone:573-795-4604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO576128904Medicaid