Provider Demographics
NPI:1245466713
Name:CRANDALL, RYAN C (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2290
Mailing Address - Country:US
Mailing Address - Phone:419-785-4415
Mailing Address - Fax:419-785-4735
Practice Address - Street 1:851 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2770
Practice Address - Country:US
Practice Address - Phone:419-782-8808
Practice Address - Fax:419-782-8148
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist