Provider Demographics
NPI:1184195950
Name:HARKINS, RYAN R (PTA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:R
Last Name:HARKINS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 N MAPLE AVE APT 54
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1716
Mailing Address - Country:US
Mailing Address - Phone:856-261-0639
Mailing Address - Fax:
Practice Address - Street 1:31 N MAPLE AVE APT 54
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1716
Practice Address - Country:US
Practice Address - Phone:856-261-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00306000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant