Healthcare Provider Details

I. General information

NPI: 1154906022
Provider Name (Legal Business Name): RYAN TAGLIAMONTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 09/11/2025
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 PHILADELPHIA PIKE
CLAYMONT DE
19703-2568
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 302-408-7310
  • Fax: 302-916-4817
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT030085
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: