Basic Information
| Provider Information | |||||||||
| NPI: | 1972944122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LADISLAS | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2949 JOHN HAWKINS PKWY | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352441095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053961530 | ||||||||
| FaxNumber: | 2053961535 | ||||||||
| Practice Location | |||||||||
| Address1: | 2949 JOHN HAWKINS PKWY | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352441095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053961530 | ||||||||
| FaxNumber: | 2053961535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 09/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | PTL.0011451 | CO | N | Other Service Providers | Military Health Care Provider | 225100000X | PTH7643 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.