Provider Demographics
NPI:1851539860
Name:RYAN, MEGHAN ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EDGEMERE ST
Mailing Address - Street 2:ROOM 202
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-5144
Mailing Address - Country:US
Mailing Address - Phone:631-668-1372
Mailing Address - Fax:631-668-1374
Practice Address - Street 1:240 EDGEMERE ST
Practice Address - Street 2:ROOM 202
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-5144
Practice Address - Country:US
Practice Address - Phone:631-668-1372
Practice Address - Fax:631-668-1374
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ893A1OtherEPIN
NY11936109OtherCAQH
NYA400110167Medicare PIN