Provider Demographics
NPI:1134801608
Name:SHIPLEY, RYAN ALLEN (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALLEN
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E HALLANDALE BEACH BLVD # 560
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4619
Mailing Address - Country:US
Mailing Address - Phone:786-763-2272
Mailing Address - Fax:
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:786-763-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist