Provider Demographics
NPI:1356098164
Name:RYAN, MARIA E (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:DEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1651 N 86TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3719
Mailing Address - Country:US
Mailing Address - Phone:402-484-7117
Mailing Address - Fax:402-484-7118
Practice Address - Street 1:6101 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5830
Practice Address - Country:US
Practice Address - Phone:402-420-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist