Provider Demographics
NPI:1477166239
Name:FREDD, RYAN LEWIS (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:LEWIS
Last Name:FREDD
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 1:20268 PLANTATIONS RD STE B
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4622
Mailing Address - Country:US
Mailing Address - Phone:302-727-0075
Mailing Address - Fax:
Practice Address - Street 1:20268 PLANTATIONS RD STE B
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4622
Practice Address - Country:US
Practice Address - Phone:302-727-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0015006225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist