MEDICARE: MR. RYAN CHRISTOPHER NAKUTAVICIUS DPT

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	225100000X	Physical Therapist	029312	NY

General Provider Information

NPI Number	:	1700083318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN CHRISTOPHER NAKUTAVICIUS DPT

Provider Business Mailing Address
First Line	:	2403 PARKVIEW PL
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-3442
Country	:	US
Telephone Number	:	516-867-9215
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 MADISON AVE
Second Line	:	BOX 1674
City	:	NEW YORK
State	:	NY
Zip	:	10029-6508
Country	:	US
Telephone Number	:	917-457-0421
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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