Provider Demographics
NPI:1720178825
Name:MARTIN, RYAN S (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-1828
Mailing Address - Country:US
Mailing Address - Phone:207-935-7770
Mailing Address - Fax:
Practice Address - Street 1:37 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6166
Practice Address - Country:US
Practice Address - Phone:603-447-2533
Practice Address - Fax:603-447-2533
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3194225100000X
NH3424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHME222502Medicare PIN