Provider Demographics
NPI:1811189202
Name:RYAN, STEFANIE L (PT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:L
Other - Last Name:DEDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2827 US HIGHWAY 9
Mailing Address - Street 2:OCEAN STATE JOB LOTS PLAZA
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184
Mailing Address - Country:US
Mailing Address - Phone:518-758-7616
Mailing Address - Fax:
Practice Address - Street 1:2827 US HIGHWAY 9
Practice Address - Street 2:OCEAN STATE JOB LOTS PLAZA
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029538225100000X
NY029538-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist