Provider Demographics
NPI:1275684177
Name:RYAN, THERESA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:LYNN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1854 SAINT MARGARETS RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5943
Mailing Address - Country:US
Mailing Address - Phone:410-757-8976
Mailing Address - Fax:
Practice Address - Street 1:7745 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3316
Practice Address - Country:US
Practice Address - Phone:301-345-5687
Practice Address - Fax:301-345-5881
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD004316K20Medicare ID - Type Unspecified