Provider Demographics
NPI:1518114669
Name:RYALL, CAROL ANN
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:RYALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 GOLD STAR HWY
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2717
Mailing Address - Country:US
Mailing Address - Phone:860-865-0825
Mailing Address - Fax:860-865-0826
Practice Address - Street 1:1313 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2717
Practice Address - Country:US
Practice Address - Phone:860-865-0825
Practice Address - Fax:860-865-0826
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter