Provider Demographics
NPI:1679098982
Name:BILLICH, RYAN (PT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BILLICH
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 1:581 BOYLSTON ST
Mailing Address - Street 2:STE 404
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3624
Mailing Address - Country:US
Mailing Address - Phone:908-834-1800
Mailing Address - Fax:
Practice Address - Street 1:581 BOYLSTON ST
Practice Address - Street 2:STE 404
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3624
Practice Address - Country:US
Practice Address - Phone:908-834-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist