Provider Demographics
NPI:1467449744
Name:RYAN, TIMOTHY DENNIS (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DENNIS
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 1:3830 N GRIMES ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1279
Mailing Address - Country:US
Mailing Address - Phone:575-392-3971
Mailing Address - Fax:575-392-4169
Practice Address - Street 1:3830 N GRIMES ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1279
Practice Address - Country:US
Practice Address - Phone:575-392-3971
Practice Address - Fax:575-392-4169
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist