Healthcare Provider Details

I. General information

NPI: 1134298862
Provider Name (Legal Business Name): RYAN OYOS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERFRONT DR
LITTLE ROCK AR
72202
US

IV. Provider business mailing address

900 CEDAR RIDGE DR
LITTLE ROCK AR
72211-3122
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 501-940-1772
  • Fax: 501-227-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 1684
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: