Provider Demographics
NPI:1649155169
Name:BRYANT, PHILA
Entity type:Individual
Prefix:
First Name:PHILA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:OFFERMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31556-0184
Mailing Address - Country:US
Mailing Address - Phone:912-281-4211
Mailing Address - Fax:
Practice Address - Street 1:4480 S COBB DR SE STE Y
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6984
Practice Address - Country:US
Practice Address - Phone:770-438-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist