Provider Demographics
NPI:1568906501
Name:RYAN, DAPHNE LEE (PT)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E KEN PRATT BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5311
Mailing Address - Country:US
Mailing Address - Phone:720-718-5400
Mailing Address - Fax:
Practice Address - Street 1:1760 E KEN PRATT BLVD STE 405
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:720-718-5400
Practice Address - Fax:720-718-5991
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009824171W00000X
COPTL.0008409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor