Provider Demographics
NPI:1740858513
Name:ALBERTSON, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ALBERTSON
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 1:1715 CLEARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-4414
Mailing Address - Country:US
Mailing Address - Phone:903-452-2731
Mailing Address - Fax:
Practice Address - Street 1:17 N PLANK RD STE 10
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2111
Practice Address - Country:US
Practice Address - Phone:845-800-1470
Practice Address - Fax:844-800-1470
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012510225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant