Provider Demographics
NPI:1164715082
Name:GEPHART, RYAN SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:GEPHART
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 1:373 LEATHER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7792
Mailing Address - Country:US
Mailing Address - Phone:513-260-8966
Mailing Address - Fax:
Practice Address - Street 1:373 LEATHER LEAF LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7792
Practice Address - Country:US
Practice Address - Phone:513-260-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist