Provider Demographics
NPI:1598762445
Name:RYU, MAUREEN A (DPT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:RYU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:MCHUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:771 PILOT HOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:6161 KEMPSVILLE CIRCLE
Practice Address - Street 2:STE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-965-4890
Practice Address - Fax:757-965-4893
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050056862251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192967OtherBCBS PHY THERAPY
VAP00398192OtherRAILROAD MEDICARE
VA102000OtherANTHEM BCBS
VA1598762445Medicaid
VA7003161OtherAETNA
VA1598762445Medicaid
VA7003161OtherAETNA