Provider Demographics
NPI:1740265388
Name:KING, RYAN D (PT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:KING
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 1:6005 PINE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-3271
Mailing Address - Country:US
Mailing Address - Phone:814-838-1210
Mailing Address - Fax:
Practice Address - Street 1:2850 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2920
Practice Address - Country:US
Practice Address - Phone:814-899-1023
Practice Address - Fax:814-898-2456
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist