Provider Demographics
NPI:1285025650
Name:RYBURN, EARL WARREN JR (COTA)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:WARREN
Last Name:RYBURN
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14500 BLANCO RD
Mailing Address - Street 2:APT 1324
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7858
Mailing Address - Country:US
Mailing Address - Phone:210-325-7330
Mailing Address - Fax:
Practice Address - Street 1:7555 NW LOOP 410
Practice Address - Street 2:#114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2353
Practice Address - Country:US
Practice Address - Phone:210-325-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208800283X00000X, 261QP2000X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No273Y00000XHospital UnitsRehabilitation Unit