Provider Demographics
NPI:1366653693
Name:RYAN, JOAN ELIZABETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ELIZABETH
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ELIZABETH
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:718 WEATHERVANE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9642
Mailing Address - Country:US
Mailing Address - Phone:919-237-2164
Mailing Address - Fax:
Practice Address - Street 1:718 WEATHERVANE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9642
Practice Address - Country:US
Practice Address - Phone:919-237-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10698-24225100000X
NC11105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist