Provider Demographics
NPI:1942754304
Name:BIRCHALL, RYAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BIRCHALL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-0003
Mailing Address - Country:US
Mailing Address - Phone:617-623-6303
Mailing Address - Fax:617-242-7074
Practice Address - Street 1:233 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2457
Practice Address - Country:US
Practice Address - Phone:617-926-2300
Practice Address - Fax:617-926-5886
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22583OtherPT LICENSE