Provider Demographics
NPI:1013132869
Name:RYAN, EDWARD DAVIS (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DAVIS
Last Name:RYAN
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 1:1626 HASTINGS CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-2629
Mailing Address - Country:US
Mailing Address - Phone:678-936-0343
Mailing Address - Fax:678-450-6931
Practice Address - Street 1:1626 HASTINGS CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-2629
Practice Address - Country:US
Practice Address - Phone:678-936-0343
Practice Address - Fax:678-450-6931
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0081012251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics