Provider Demographics
NPI:1437101813
Name:YAMADA, RYAN L (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:YAMADA
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 1:5152 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2550
Mailing Address - Country:US
Mailing Address - Phone:805-681-9108
Mailing Address - Fax:805-681-9208
Practice Address - Street 1:5152 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2550
Practice Address - Country:US
Practice Address - Phone:805-681-9108
Practice Address - Fax:805-681-9208
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT286970OtherBLUE CROSS BLUE SHIELD
CAHB957ZMedicare PIN
CAOPT286970OtherBLUE CROSS BLUE SHIELD
CAWPT28687AMedicare PIN