Provider Demographics
NPI:1922105253
Name:DEWITT, RYAN (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:DEWITT
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 1:4125 PORTOLA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4525
Mailing Address - Country:US
Mailing Address - Phone:831-475-2565
Mailing Address - Fax:831-475-2572
Practice Address - Street 1:4125 PORTOLA DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4525
Practice Address - Country:US
Practice Address - Phone:831-475-2565
Practice Address - Fax:831-475-2572
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist