Healthcare Provider Details

I. General information

NPI: 1427255629
Provider Name (Legal Business Name): RYAN PRENTICE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4429 NW 93RD WAY
SUNRISE FL
33351-5252
US

IV. Provider business mailing address

4429 NW 93RD WAY
SUNRISE FL
33351-5252
US

V. Phone/Fax

Practice location:
  • Phone: 58-773-2623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: