Healthcare Provider Details

I. General information

NPI: 1891739702
Provider Name (Legal Business Name): RYAN LEO HEMELT DPT MOTR L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ORTHOPAEDIC PL
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

965 SALTWATER CIR
ST AUGUSTINE FL
32080-6305
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax: 904-209-1057
Mailing address:
  • Phone: 904-460-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT21456
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT11336
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: