Provider Demographics
NPI:1770291130
Name:MCNULTY, RYAN BARRY
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:BARRY
Last Name:MCNULTY
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 1:45560 READING TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-3048
Mailing Address - Country:US
Mailing Address - Phone:571-286-2630
Mailing Address - Fax:
Practice Address - Street 1:44125 WOODRIDGE PKWY STE LEESBURG
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8281
Practice Address - Country:US
Practice Address - Phone:157-129-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician