Provider Demographics
NPI:1053473710
Name:BRYAN, TIFFANY A (DPT)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:A
Last Name:BRYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:QUINLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:11129 GOLDEN SILENCE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2344
Mailing Address - Country:US
Mailing Address - Phone:304-543-0534
Mailing Address - Fax:
Practice Address - Street 1:3411 UNIVERSITY AVE STE 1
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-7219
Practice Address - Country:US
Practice Address - Phone:304-598-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV002345225100000X
FL28975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1063610OtherWORKERS COMP
WA7607536OtherAETNA
WV311504453OtherACORDIA
WV311504453OtherCIGNA
WV3810000-211Medicaid
WV1714910OtherBLUE CROSS BLUE SHIELD
WV3810000-211Medicaid
WV311504453OtherCIGNA
WVQU4125831Medicare ID - Type UnspecifiedHURRICANE, WV CLINIC