Provider Demographics
NPI:1831513993
Name:RYAN, CAITLIN (MS, ATC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 COOPER DR
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4732
Mailing Address - Country:US
Mailing Address - Phone:908-670-1646
Mailing Address - Fax:
Practice Address - Street 1:55 COOPER DR
Practice Address - Street 2:APT 2A
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4732
Practice Address - Country:US
Practice Address - Phone:908-670-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0023512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer