Provider Demographics
NPI:1184339046
Name:RYMAN, MEGAN TRACEY
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:TRACEY
Last Name:RYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26205 GREEN WILLOW RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-2417
Mailing Address - Country:US
Mailing Address - Phone:813-995-1244
Mailing Address - Fax:
Practice Address - Street 1:4803 SEABERG RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-2862
Practice Address - Country:US
Practice Address - Phone:954-649-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRPS.0100988.A101YM0800X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach