Provider Demographics
NPI:1679955371
Name:MAYNES, RYAN J (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:MAYNES
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 1:12B N UNIVERSITY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5205
Mailing Address - Country:US
Mailing Address - Phone:509-818-0086
Mailing Address - Fax:
Practice Address - Street 1:12B N UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5205
Practice Address - Country:US
Practice Address - Phone:509-818-0086
Practice Address - Fax:509-606-0439
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60546430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist