Individual
MRS. TARA L. BRYAN
Active
Individual
MRS. TARA L. BRYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140792
BLUE CROSS BLUE SHIELD
KS
05
—
200277920A
—
KS
01
—
646300
FIRST GUARD GROUP NUMBER
KS
Enumeration date
10/03/2006
Last updated
11/15/2024
Update your record
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