Provider Demographics
NPI:1346309218
Name:TOLLIVER, RYAN SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:TOLLIVER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4914
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:1400 CUMBERLAND FALLS HWY STE C
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2739
Practice Address - Country:US
Practice Address - Phone:606-528-2149
Practice Address - Fax:606-528-2338
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0701703Medicare PIN