Provider Demographics
NPI:1114563822
Name:HARPER, RYAN ALLEN (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALLEN
Last Name:HARPER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7462 W KAREN LEE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4828
Mailing Address - Country:US
Mailing Address - Phone:623-692-6315
Mailing Address - Fax:
Practice Address - Street 1:21391 N LAKE PLEASANT PKWY STE 1810
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2000
Practice Address - Country:US
Practice Address - Phone:623-289-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist