Bryan Kristoffer De la Silva

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13655 Issued in TN

Practice address

911 Old Humboldt Rd
Jackson, TN 38305-5668

Phone

(731) 256-5762

NPI assigned

Jul 6, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1396478525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 CHAMPIONS DR APT 6C",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242587",
            "telephone_number": "662-760-2179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 OLD HUMBOLDT RD",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383055668",
            "telephone_number": "731-256-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA SILVA",
        "first_name": "BRYAN KRISTOFFER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P19888",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "13655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sameer Lowai Dawoodi, M.D.
• Dale Dawson, P.A.
• James Daniel Day, MD
• Mary Day, PHARMD
• Tracy Day, CRNA
• Mary Blondell Deal, APN
• Kristen Deaton
• Angela Deberry
• Akacyea Nycole Deck, PA-C
• Brian Richard Decosta, M.D.

• Physical Therapist in Jackson, TN
• Providers in Jackson, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.