Provider Demographics
NPI:1922245539
Name:RYAN, SANDRA ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EMMONS ST.
Mailing Address - Street 2:
Mailing Address - City:DANNEMORA
Mailing Address - State:NY
Mailing Address - Zip Code:12929-0844
Mailing Address - Country:US
Mailing Address - Phone:518-492-9759
Mailing Address - Fax:
Practice Address - Street 1:133 MARGARET ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2926
Practice Address - Country:US
Practice Address - Phone:518-565-4798
Practice Address - Fax:518-565-4509
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011663-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011663-1OtherPHYSICAL THERAPY REGISTRATION CERTIFICATE