Provider Demographics
NPI:1740499003
Name:BARRY, RYAN C (MPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:C
Last Name:BARRY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 S DELAWARE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5918
Mailing Address - Country:US
Mailing Address - Phone:918-744-8954
Mailing Address - Fax:918-712-7813
Practice Address - Street 1:4815 S HARVARD AVE STE 455
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3078
Practice Address - Country:US
Practice Address - Phone:918-712-7895
Practice Address - Fax:918-712-7813
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist