Provider Demographics
NPI:1609228493
Name:RYAN, RONALD (PT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK WEST DR
Mailing Address - Street 2:STE B
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-8902
Mailing Address - Country:US
Mailing Address - Phone:337-769-1556
Mailing Address - Fax:337-769-1557
Practice Address - Street 1:101 PARK WEST DR
Practice Address - Street 2:STE B
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8902
Practice Address - Country:US
Practice Address - Phone:337-769-1556
Practice Address - Fax:337-769-1557
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01738R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist