Individual
MRS. TIFFANY A BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3411 UNIVERSITY AVE STE 1, MORGANTOWN, WV 26505-7219
(304) 598-3221
Mailing address
11129 GOLDEN SILENCE DR, RIVERVIEW, FL 33579-2344
(304) 543-0534
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
28975
FL
225100000X
Physical Therapist
Primary
WV002345
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063610
WORKERS COMP
WV
01
—
1714910
BLUE CROSS BLUE SHIELD
WV
01
—
311504453
ACORDIA
WV
05
—
3810000-211
—
WV
01
—
7607536
AETNA
WA
Enumeration date
12/15/2006
Last updated
06/03/2021
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