Individual
EDITH BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070015678
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP
IL
01
—
567700
MEDICARE GROUP NUMBER
IL
01
—
568080
MEDICARE GROUP NUMBER
IL
01
—
568150
MEDICARE GROUP NUMBER
IL
Enumeration date
04/02/2007
Last updated
04/06/2011
Update your record
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