Provider Demographics
NPI:1093848376
Name:RYAN, LEAH M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 N BROADWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2501
Mailing Address - Country:US
Mailing Address - Phone:918-649-0799
Mailing Address - Fax:918-649-0797
Practice Address - Street 1:2104 N BROADWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2501
Practice Address - Country:US
Practice Address - Phone:918-649-0799
Practice Address - Fax:918-649-0797
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1477225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant