Provider Demographics
NPI:1730286410
Name:RYAN, SEAN CASEY (PT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CASEY
Last Name:RYAN
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 1:1912 S PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6118
Mailing Address - Country:US
Mailing Address - Phone:310-540-5758
Mailing Address - Fax:310-540-5404
Practice Address - Street 1:1912 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6118
Practice Address - Country:US
Practice Address - Phone:310-540-5758
Practice Address - Fax:310-540-5404
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist