Provider Demographics
NPI:1235407651
Name:VAN RYEN-SINK, GWEN MARY (PT/ATC)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:MARY
Last Name:VAN RYEN-SINK
Suffix:
Gender:F
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21221 BALTIC DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6424
Mailing Address - Country:US
Mailing Address - Phone:704-895-3359
Mailing Address - Fax:
Practice Address - Street 1:514 WILLIAMSON RD
Practice Address - Street 2:SUITE 431
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9225
Practice Address - Country:US
Practice Address - Phone:704-360-2595
Practice Address - Fax:704-360-2596
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist