Provider Demographics
NPI:1083021026
Name:RYAN, BRIANNA (DPT)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 ELM ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2950
Mailing Address - Country:US
Mailing Address - Phone:617-623-6300
Mailing Address - Fax:
Practice Address - Street 1:259 ELM ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2950
Practice Address - Country:US
Practice Address - Phone:617-623-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic