Provider Demographics
NPI:1609023688
Name:DECARREAU, RYAN M (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:M
Last Name:DECARREAU
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 1:564 HORACE EMMET WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31409-5313
Mailing Address - Country:US
Mailing Address - Phone:912-315-4521
Mailing Address - Fax:
Practice Address - Street 1:564 HORACE EMMET WILSON BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5313
Practice Address - Country:US
Practice Address - Phone:912-315-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist