Provider Demographics
NPI:1306830328
Name:RYAN-SWANSON, MARIANNE (PT, OCS)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:RYAN-SWANSON
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W END AVE APT 12H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5545
Mailing Address - Country:US
Mailing Address - Phone:212-661-2933
Mailing Address - Fax:212-661-2935
Practice Address - Street 1:185 W END AVE APT 12H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5545
Practice Address - Country:US
Practice Address - Phone:212-661-2933
Practice Address - Fax:212-661-2935
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ53331Medicare ID - Type UnspecifiedMEDICARE