Individual
BRYAN KRISTOFFER DE LA SILVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
911 OLD HUMBOLDT RD, JACKSON, TN 38305-5668
(731) 256-5762
Mailing address
2025 CHAMPIONS DR APT 6C, DYERSBURG, TN 38024-2587
(662) 760-2179
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13655
TN
225100000X
Physical Therapist
P19888
NC
Other
Enumeration date
07/06/2022
Last updated
07/28/2022
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