1649507799 NPI number — HOLLY KATHERINE BRYANT PT, DPT

Table of content: HOLLY KATHERINE BRYANT PT, DPT (NPI 1649507799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649507799 NPI number — HOLLY KATHERINE BRYANT PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANT
Provider First Name:
HOLLY
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FORREST
Provider Other First Name:
HOLLY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649507799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11660 ALPHARETTA HWY
Provider Second Line Business Mailing Address:
SUITE 560
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-4943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-753-9195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11660 ALPHARETTA HWY
Provider Second Line Business Practice Location Address:
SUITE 560
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-4943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-753-9195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT009564 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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