Basic Information
| Provider Information | |||||||||
| NPI: | 1962448837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOYT | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | COLLLINS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 W LONE CACTUS DR | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850272257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807767916 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21410 N 19TH AVE | ||||||||
| Address2: | SUITE #151 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850272738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235949034 | ||||||||
| FaxNumber: | 6235949868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 174400000X | 6844 | AZ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 6844 | 01 | AZ | PT LICENSE | OTHER |