Provider Demographics
NPI:1164434007
Name:TAUZELL, RYAN ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ANTHONY
Last Name:TAUZELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 W INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3500
Mailing Address - Country:US
Mailing Address - Phone:336-783-9400
Mailing Address - Fax:336-786-9406
Practice Address - Street 1:304 DAVIS ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348
Practice Address - Country:US
Practice Address - Phone:276-773-1845
Practice Address - Fax:276-773-3912
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052036052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC9495OtherMEDCOST
WV1064682OtherWORKERS COMPENSATION
VA267063OtherBLUE CROSS BLUE SHIELD VA
002881V76Medicare ID - Type UnspecifiedMEDICARE
VA267063OtherBLUE CROSS BLUE SHIELD VA