Provider Demographics
NPI:1336797760
Name:BARCELONA, RYAN BRAND (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:BRAND
Last Name:BARCELONA
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 1:5809 GOLD CREST DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-8811
Mailing Address - Country:US
Mailing Address - Phone:318-415-9931
Mailing Address - Fax:
Practice Address - Street 1:5809 GOLD CREST DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-8811
Practice Address - Country:US
Practice Address - Phone:318-415-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist