Provider Demographics
NPI:1306391040
Name:MASTROPAOLO, RYAN LEE (LPTA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:MASTROPAOLO
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 LEE OAKS PL
Mailing Address - Street 2:APT 101
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-7345
Mailing Address - Country:US
Mailing Address - Phone:207-232-4619
Mailing Address - Fax:
Practice Address - Street 1:2806 LEE OAKS PL
Practice Address - Street 2:APT 101
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-7345
Practice Address - Country:US
Practice Address - Phone:207-232-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603629225200000X
VARBT-16-17379103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst