Healthcare Provider Details

I. General information

NPI: 1841764255
Provider Name (Legal Business Name): MR. PAUL F RYLEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4456 CORTEZ RD W
BRADENTON FL
34210-3141
US

IV. Provider business mailing address

4456 CORTEZ RD W
BRADENTON FL
34210-3141
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-6966
  • Fax:
Mailing address:
  • Phone: 941-747-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: