Provider Demographics
NPI:1013106913
Name:RYAN, ERICA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ANNE
Other - Last Name:SHIFFLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 MARBLE H 136
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632
Mailing Address - Country:US
Mailing Address - Phone:720-648-7232
Mailing Address - Fax:970-569-3884
Practice Address - Street 1:142 E BEAVER CREEK BLVD UNIT 109
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620-4800
Practice Address - Country:US
Practice Address - Phone:970-790-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066579Medicare Oscar/Certification
COC474948Medicare PIN