Provider Demographics
NPI:1346384740
Name:RYAN, MARY CECELIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CECELIA
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 CALLE LINDA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4026
Mailing Address - Country:US
Mailing Address - Phone:909-592-8458
Mailing Address - Fax:909-592-0170
Practice Address - Street 1:1446 CALLE LINDA
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4026
Practice Address - Country:US
Practice Address - Phone:909-592-8458
Practice Address - Fax:909-592-0170
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist