Provider Demographics
NPI:1710596671
Name:FITES, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FITES
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 1:5015 W LIBERTY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7940
Mailing Address - Country:US
Mailing Address - Phone:843-709-5875
Mailing Address - Fax:
Practice Address - Street 1:5015 W LIBERTY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7940
Practice Address - Country:US
Practice Address - Phone:843-709-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist