Basic Information
| Provider Information | |||||||||
| NPI: | 1992748362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOWNS | ||||||||
| FirstName: | BRYAN | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PT, OCS, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 408 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | INDIALANTIC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329034280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217272707 | ||||||||
| FaxNumber: | 3214098371 | ||||||||
| Practice Location | |||||||||
| Address1: | 2030 S PATRICK DR | ||||||||
| Address2: | |||||||||
| City: | INDIAN HARBOUR BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329374400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217272707 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT16173 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.