Provider Demographics
NPI:1417983677
Name:RYAN, ELAINE (PT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:VAN DEVENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 HOSPITAL CENTER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-8702
Mailing Address - Country:US
Mailing Address - Phone:843-671-7342
Mailing Address - Fax:843-671-7343
Practice Address - Street 1:8 HOSPITAL CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-8702
Practice Address - Country:US
Practice Address - Phone:843-671-7342
Practice Address - Fax:843-671-7343
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00437036OtherRAILROAD MEDICARE NUMBER
SCQ333018783Medicare PIN
SCQ333018783Medicare PIN