Healthcare Provider Details

I. General information

NPI: 1174138408
Provider Name (Legal Business Name): RYAN MURPHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 06/21/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MAJORCA AVE
CORAL GABLES FL
33134-4553
US

IV. Provider business mailing address

75A SCOTLAND BLVD
BRIDGEWATER MA
02324-2302
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-3583
  • Fax:
Mailing address:
  • Phone: 508-697-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25196
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: