Provider Demographics
NPI:1609187343
Name:KINNAS, BRYCE THOMAS (DPT)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:THOMAS
Last Name:KINNAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 WILDWOOD LAKES BLVD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6428
Mailing Address - Country:US
Mailing Address - Phone:239-285-3434
Mailing Address - Fax:239-354-3721
Practice Address - Street 1:1374 WILDWOOD LAKES BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6428
Practice Address - Country:US
Practice Address - Phone:239-285-3434
Practice Address - Fax:239-354-3721
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist