Basic Information
| Provider Information | |||||||||
| NPI: | 1184098980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALISBURY | ||||||||
| FirstName: | BRYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 WOODLAKE CT APT F | ||||||||
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| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615932 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 313 HOSPITAL DR | ||||||||
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| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107611222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2015 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A3574 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.