Provider Demographics
NPI:1922588037
Name:MUSSELL, RYAN JOSEPH J
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH J
Last Name:MUSSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 ETHERIDGE MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILNER
Mailing Address - State:GA
Mailing Address - Zip Code:30257-3782
Mailing Address - Country:US
Mailing Address - Phone:678-603-9364
Mailing Address - Fax:
Practice Address - Street 1:747 S 8TH ST STE D
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4884
Practice Address - Country:US
Practice Address - Phone:770-229-6498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist