Provider Demographics
NPI:1891739702
Name:HEMELT, RYAN LEO (DPT MOTR L)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEO
Last Name:HEMELT
Suffix:
Gender:M
Credentials:DPT MOTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 SALTWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6305
Mailing Address - Country:US
Mailing Address - Phone:904-460-0079
Mailing Address - Fax:
Practice Address - Street 1:1 ORTHOPAEDIC PL
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4202
Practice Address - Country:US
Practice Address - Phone:904-825-0540
Practice Address - Fax:904-209-1057
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT214562251X0800X
FLOT11336225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002844900Medicaid
P00667168OtherMEDICARE RAILROAD
FL1174540001OtherCIGNA GOVT SVCS DMERC
P00667168OtherMEDICARE RAILROAD
FL1174540001OtherCIGNA GOVT SVCS DMERC
FLU7921WMedicare PIN
FLBX754ZMedicare PIN