Provider Demographics
NPI:1467851055
Name:ORNER, RYAN J (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:ORNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:10722 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2138
Practice Address - Country:US
Practice Address - Phone:301-476-4529
Practice Address - Fax:301-476-4519
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25210225100000X
PAPT023791261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1035095OtherCIGNA
MD292158OtherJHHC
MDF7170037OtherCAREFIRST
MD091173900Medicaid
MD091173900Medicaid