Healthcare Provider Details

I. General information

NPI: 1447088257
Provider Name (Legal Business Name): RYAN YEAGER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 20TH ST NW FRNT 1
WASHINGTON DC
20036-3411
US

IV. Provider business mailing address

2135 NEWPORT PL NW APT 3
WASHINGTON DC
20037-3056
US

V. Phone/Fax

Practice location:
  • Phone: 240-825-2561
  • Fax:
Mailing address:
  • Phone: 717-461-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2000023
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: