Provider Demographics
NPI:1447927991
Name:MEDVES, RYAN MATHEW (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MATHEW
Last Name:MEDVES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5321
Mailing Address - Country:US
Mailing Address - Phone:419-626-4162
Mailing Address - Fax:
Practice Address - Street 1:164 MILAN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1146
Practice Address - Country:US
Practice Address - Phone:419-660-0876
Practice Address - Fax:419-660-9104
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT019487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist