Provider Demographics
NPI:1780278085
Name:MICHAELS, RYAN JAMES (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ELM DR
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2617
Mailing Address - Country:US
Mailing Address - Phone:724-728-4893
Mailing Address - Fax:
Practice Address - Street 1:2284 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4685
Practice Address - Country:US
Practice Address - Phone:724-788-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA200510571208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation