Dale Owen Bryan
Individual provider Active NPI Physical Therapist · Douglas, AZ
NPI 1124244264 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124244264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5622 (AZ)
- Practice address
- 2331 E 15TH St
Douglas, AZ 85607-2505 - Phone
- (520) 226-4184
- NPI assigned
- Apr 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5622 | AZ | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5622 | AZ | Yes |
Addresses
Primary practice location
2331 E 15TH St
Douglas, AZ 85607-2505
Mailing address
2331 E 15TH St
Douglas, AZ 85607-2505
Other providers in Douglas, AZ
- Brian Beltran
- Bisbee Hospital Association
- Bisbee Hospital Association
- Jacob Bonilla
- Anne M. Brasher
- Stacey Calderon
- Natividad Cano
- Caring Connections for Special Needs, LLC
- Yolanda S Caruso
- Jennifer Chamness
All providers in Douglas, AZ · Physical Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.