Individual
BRYCE FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
101 E 9TH ST, PANA, IL 62557-1716
(217) 562-6238
Mailing address
101 E 9TH ST, PANA, IL 62557-1716
(217) 562-6238
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070.018169
IL
Other
Enumeration date
06/12/2012
Last updated
07/08/2021
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