Provider Demographics
NPI:1376034769
Name:CULLEN, RYAN THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:CULLEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1135 STONERCREST BLVD
Practice Address - Street 2:STE 103
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6559
Practice Address - Country:US
Practice Address - Phone:803-547-9940
Practice Address - Fax:803-547-9942
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist