Individual
MR. BRYAN FEDERICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DOCTOR OF PHYSICAL T
Contact information
Practice address
907 BUFFALO ST, JOHNSON CITY, TN 37604-6719
(423) 430-6611
(423) 815-1051
Mailing address
907 BUFFALO ST, JOHNSON CITY, TN 37604-6719
(423) 430-6611
(423) 815-1051
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05146R
LA
225100000X
Physical Therapist
12513
TN
225100000X
Physical Therapist
8823
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000012513
LICENSE
TN
01
—
05146R
PHYSICAL THERAPY LICENSE
LA
Enumeration date
11/28/2006
Last updated
12/02/2025
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