Provider Demographics
NPI:1235574096
Name:SPANO, RYAN (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SPANO
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 1:1290 FRONT ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2000
Mailing Address - Country:US
Mailing Address - Phone:985-326-7260
Mailing Address - Fax:985-326-7261
Practice Address - Street 1:1290 FRONT ST STE 1B
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2000
Practice Address - Country:US
Practice Address - Phone:985-326-7260
Practice Address - Fax:985-326-7261
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist