Provider Demographics
NPI:1770605719
Name:RYAN, ROBERT (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:RYAN
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 1:532 W HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5322
Mailing Address - Country:US
Mailing Address - Phone:407-353-4089
Mailing Address - Fax:
Practice Address - Street 1:160 ISLANDER CT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4925
Practice Address - Country:US
Practice Address - Phone:407-767-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8704225100000X
CT004298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist