Provider Demographics
NPI:1417458985
Name:GREEN, RYAN ERIC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ERIC
Last Name:GREEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5494
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:711 W 40TH ST STE 352
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2100
Practice Address - Country:US
Practice Address - Phone:410-243-5399
Practice Address - Fax:410-243-5366
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist