Provider Demographics
NPI:1598238800
Name:DANIELS, RYAN HUNTER (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:HUNTER
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7628
Mailing Address - Country:US
Mailing Address - Phone:870-612-7200
Mailing Address - Fax:870-834-0711
Practice Address - Street 1:790 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8231
Practice Address - Country:US
Practice Address - Phone:870-368-0711
Practice Address - Fax:870-368-0117
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist