Provider Demographics
NPI:1467618066
Name:WILLIAMSON, RYAN
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:8779 SPRING MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9676
Mailing Address - Country:US
Mailing Address - Phone:239-822-7345
Mailing Address - Fax:
Practice Address - Street 1:9215 BELLEZA WAY
Practice Address - Street 2:# C-203
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9624
Practice Address - Country:US
Practice Address - Phone:239-822-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA15971225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant