Most Relevant Information
Provider Data
| NPI Number: | 1003230103 |
| Provider Name: | BRYANNA OSWALT |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | IMT1742 |
Most Important Dates
| Enumeration Date: | 02/10/2014 |
| Last Updated: | 02/10/2014 |
Provider Practice Location
4450 W EAU GALLIE BLVD
SUITE 200
MELBOURNE
FL
329347213
Practice Location Phone/Fax
| Phone: | 3217262860 |
| Fax: |
Provider Mailing Location
400 SHERIDAN RD
MELBOURNE
FL
329013122
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |