Provider Demographics
NPI:1225319452
Name:ARDOIN, RYAN LEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:ARDOIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:REHABILITATION CARE LINE STE 2B-435
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4211
Mailing Address - Country:US
Mailing Address - Phone:713-794-7117
Mailing Address - Fax:713-794-7631
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:REHABILITATION CARE LINE STE 2B-435
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-794-7117
Practice Address - Fax:713-794-7631
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12086322251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1208632OtherTX LICENSE