Provider Demographics
NPI:1326216920
Name:BROMS, RYAN CANAAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CANAAN
Last Name:BROMS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 MIRAMONTE AVE UNIT 3791
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-9030
Mailing Address - Country:US
Mailing Address - Phone:650-305-8097
Mailing Address - Fax:
Practice Address - Street 1:1525 MIRAMONTE AVE UNIT 3791
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-9030
Practice Address - Country:US
Practice Address - Phone:650-305-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist