Provider Demographics
NPI:1336556612
Name:MEGHAN RYAN PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:MEGHAN RYAN PHYSICAL THERAPY, PC
Other - Org Name:MONTAUK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-668-1372
Mailing Address - Street 1:240 EDGEMERE ST
Mailing Address - Street 2:RM 202
Mailing Address - City:MONTAUK
Mailing Address - State:NY
Mailing Address - Zip Code:11954-5144
Mailing Address - Country:US
Mailing Address - Phone:631-668-1372
Mailing Address - Fax:631-668-1374
Practice Address - Street 1:240 EDGEMERE ST
Practice Address - Street 2:RM 202
Practice Address - City:MONTAUK
Practice Address - State:NY
Practice Address - Zip Code:11954-5144
Practice Address - Country:US
Practice Address - Phone:631-668-1372
Practice Address - Fax:631-668-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100110157Medicare PIN