Provider Demographics
NPI:1427190958
Name:RYAN, STEPHEN JOSEPH (PT)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:RYAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 MARTIN LUTHER KING JR WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1309
Mailing Address - Country:US
Mailing Address - Phone:510-547-7500
Mailing Address - Fax:510-545-4225
Practice Address - Street 1:1727 MARTIN LUTHER KING JR WAY STE 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1309
Practice Address - Country:US
Practice Address - Phone:510-547-7500
Practice Address - Fax:510-545-4225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT241861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00316161OtherRAILROAD MEDICARE
CA0PT241861Medicare PIN