Provider Demographics
NPI:1871291781
Name:MATTHEWS, RYAN (PTA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6870 HEUERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-9605
Mailing Address - Country:US
Mailing Address - Phone:210-610-9097
Mailing Address - Fax:
Practice Address - Street 1:6870 HEUERMANN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9605
Practice Address - Country:US
Practice Address - Phone:210-610-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2170053225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant