Healthcare Provider Details

I. General information

NPI: 1932018082
Provider Name (Legal Business Name): SAVANNAH RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 CAMINO DE LOS MARES STE 110
SAN CLEMENTE CA
92673-2808
US

IV. Provider business mailing address

28188 MOULTON PKWY APT 2528
LAGUNA NIGUEL CA
92677-7524
US

V. Phone/Fax

Practice location:
  • Phone: 949-496-0122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: