Provider Demographics
NPI:1083043467
Name:KAPROWSKI, RYAN (PTA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KAPROWSKI
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 1:421 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:PA
Mailing Address - Zip Code:18651-1617
Mailing Address - Country:US
Mailing Address - Phone:570-239-4682
Mailing Address - Fax:
Practice Address - Street 1:401 HAZLE TOWNSHIP BLVD
Practice Address - Street 2:403 HAZLE TOWNSHIP BLVD
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-9661
Practice Address - Country:US
Practice Address - Phone:570-454-8888
Practice Address - Fax:570-459-9252
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant