Provider Demographics
NPI:1649722695
Name:VICK, RYAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:VICK
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 1:534 N. ELM STREET
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4624
Mailing Address - Country:US
Mailing Address - Phone:940-566-5714
Mailing Address - Fax:940-381-0157
Practice Address - Street 1:534 N. ELM STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3104
Practice Address - Country:US
Practice Address - Phone:940-566-5714
Practice Address - Fax:940-381-0157
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1281123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist