Provider Demographics
NPI:1659021384
Name:PILLSY, RYAN THOMAS
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:PILLSY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17141 JOHNSTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2528
Mailing Address - Country:US
Mailing Address - Phone:239-699-8705
Mailing Address - Fax:
Practice Address - Street 1:670 GOODLETTE-FRANK RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5614
Practice Address - Country:US
Practice Address - Phone:239-316-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician