| Doctor Name: | MR. BRYAN JAMES ANTONIUS |
| NPI Number: | 1073985057 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.T. |
| License Number: | CRT-17967 |
| Business Practice Address: | 10004 204th Ave E Suite 2600 Bonney Lake, WA - 983916539 |
| Business Phone Number: | 2534463983 |
| Business Fax Number: | 2538625004 |
| Mailing Address: | 10004 204th Ave E, Suite 2600 BONNEY LAKE |
| State: | WA |
| Postal Code: | 983916539 |
| Phone Number: | 2534463983 |
| Fax Number: | 2538625004 |
| NPI Enumeration Date: | 10/29/2015 |
| NPI Last Update Date: | 10/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3402X |
| License Number: | CRT-17967 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Radiography |
| Taxonomy Definition: | |