MEDICARE: DR. RYAN JAMES UHAZIE PT, DPT, ATC,LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	AL4212	FL
2	225100000X	Physical Therapist	PT33870	FL

General Provider Information

NPI Number	:	1518326966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN JAMES UHAZIE PT, DPT, ATC,LAT

Provider Business Mailing Address
First Line	:	317 SE THANKSGIVING AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4777
Country	:	US
Telephone Number	:	772-233-5892
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 SE THANKSGIVING AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-4777
Country	:	US
Telephone Number	:	772-233-5892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2016
Last Update Date	:	12/20/2023

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