Provider Demographics
NPI:1659701779
Name:MCDEVITT, RYAN (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MCDEVITT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ROUTE 70
Mailing Address - Street 2:SUITE 19
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2300
Mailing Address - Country:US
Mailing Address - Phone:609-714-3378
Mailing Address - Fax:856-583-6004
Practice Address - Street 1:175 ROUTE 70
Practice Address - Street 2:SUITE 19
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2300
Practice Address - Country:US
Practice Address - Phone:609-714-3378
Practice Address - Fax:856-583-6004
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01529000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist