Provider Demographics
NPI:1669929097
Name:FLICK, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FLICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16229-1005
Mailing Address - Country:US
Mailing Address - Phone:724-294-0271
Mailing Address - Fax:
Practice Address - Street 1:209 1ST ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:PA
Practice Address - Zip Code:16229-1005
Practice Address - Country:US
Practice Address - Phone:724-294-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist