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Individual

NANCY J BRYANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
802 SHOUP ST, SALMON, ID 83467-4305
(208) 756-2005
(208) 756-4020
Mailing address
PO BOX 1170, SALMON, ID 83467-1170
(208) 756-2005
(208) 756-4020

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-092
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010018448
REGENCE BLUE SHIELD
ID
05
002721200
ID
01
1650588
OTHER MISC. INSURANCES
ID
01
185549800
US DEPT OF LABOR
ID
01
820517063
CHAMPUS
ID
01
T0304
BLUE CROSS
ID
Enumeration date
07/01/2005
Last updated
01/13/2010
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