Provider Demographics
NPI:1295307726
Name:MARTIN, RYAN (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MARTIN
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 1:714 S LAKE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3473
Mailing Address - Country:US
Mailing Address - Phone:803-356-4782
Mailing Address - Fax:803-996-4782
Practice Address - Street 1:714 S LAKE DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3473
Practice Address - Country:US
Practice Address - Phone:803-356-4782
Practice Address - Fax:803-996-4782
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist