Provider Demographics
NPI:1235718560
Name:RYAN, BRIGITTA (PT DPT)
Entity Type:Individual
Prefix:
First Name:BRIGITTA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:MS
Other - First Name:BRIGITTA
Other - Middle Name:
Other - Last Name:MANNINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:1994 W TOBIAS WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-4513
Mailing Address - Country:US
Mailing Address - Phone:480-309-3660
Mailing Address - Fax:
Practice Address - Street 1:21321 EAST OCOTILLO RD
Practice Address - Street 2:SUITE I122
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-309-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist