Healthcare Provider Details

I. General information

NPI: 1104994060
Provider Name (Legal Business Name): PATRICK WARREN RYKEN MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 168TH AVE
SAN LEANDRO CA
94578-2409
US

IV. Provider business mailing address

19364 LANGON PL
CASTRO VALLEY CA
94546-3260
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-6328
  • Fax:
Mailing address:
  • Phone: 510-316-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: