Provider Demographics
NPI:1811304231
Name:METTES, RYAN JAMES (LAC, LMT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:METTES
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3420
Mailing Address - Country:US
Mailing Address - Phone:631-225-2623
Mailing Address - Fax:
Practice Address - Street 1:10 OLD RIVERHEAD RD UNIT A
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1460
Practice Address - Country:US
Practice Address - Phone:631-369-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026259225700000X
NY005176171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist