Provider Demographics
NPI:1679946750
Name:ACOLICOL, RYAN FAYLUGA (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:FAYLUGA
Last Name:ACOLICOL
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 1:349 BRILLANTES SUBDIVISION, GOV. RAMOS STREET
Mailing Address - Street 2:STA. MARIA
Mailing Address - City:ZAMBOANGA CITY
Mailing Address - State:ZAMBOANGA DEL SUR
Mailing Address - Zip Code:7000
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKEVIEW AVE APT A
Practice Address - Street 2:LEONIA
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-3102
Practice Address - Country:US
Practice Address - Phone:917-691-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038034-1225100000X
PAPT024806225100000X
ZZ0019900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA