Provider Demographics
NPI:1184111262
Name:LAPLAGA, RYAN M (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:LAPLAGA
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MILL RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4830
Mailing Address - Country:US
Mailing Address - Phone:732-261-3871
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1912
Practice Address - Country:US
Practice Address - Phone:732-254-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01782500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist