MEDICARE: MYRIA J RYAN

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	225200000X	Physical Therapy Assistant	PTA18728

General Provider Information

NPI Number	:	1689312266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIA J RYAN

Provider Business Mailing Address
First Line	:	8968 DOVE VALLEY WAY
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-6800
Country	:	US
Telephone Number	:	772-342-5986
Fax Number	:

Provider Business Practice Location Address
First Line	:	8968 DOVE VALLEY WAY
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-6800
Country	:	US
Telephone Number	:	772-342-5986
Fax Number	:

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

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	05/24/2022

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