Provider Demographics
NPI: | 1528194685 |
---|---|
Name: | CHRISTOPHER RYAN LLC |
Entity Type: | Organization |
Organization Name: | CHRISTOPHER RYAN LLC |
Other - Org Name: | ITS INTEGRATED THERAPY SOLUTIONS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEMBER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SHARMILA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | QUENIMHERR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | SLP |
Authorized Official - Phone: | 310-838-1552 |
Mailing Address - Street 1: | 4455 W. 117TH ST. |
Mailing Address - Street 2: | 4TH FL. |
Mailing Address - City: | HAWTHORNE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90250-2241 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-838-1552 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4455 W 117TH ST. |
Practice Address - Street 2: | 4TH FL. |
Practice Address - City: | HAWTHORNE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90250 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-838-1552 |
Practice Address - Fax: | 310-838-1553 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-25 |
Last Update Date: | 2022-09-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103K00000X, 106E00000X, 2080P0006X, 2081N0008X, 225100000X, 225X00000X | ||
CA | 2251P0200X, 225800000X, 225XP0200X, 235Z00000X | |
CA | 16803 | 235Z00000X, 261QM1300X, 261QM1300X, 261QM1300X |
CA | 19172 | 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |