Provider Demographics
NPI:1255473609
Name:RYAN, CHRISTOPHER MICHAEL (MPT ATC CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:RYAN
Suffix:
Gender:M
Credentials:MPT ATC CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 RALSTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2866
Mailing Address - Country:US
Mailing Address - Phone:650-363-5668
Mailing Address - Fax:
Practice Address - Street 1:540 RALSTON AVE STE B
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2866
Practice Address - Country:US
Practice Address - Phone:650-363-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABD535YMedicare PIN
CAZZZ06873ZMedicare PIN