Healthcare Provider Details

I. General information

NPI: 1255427795
Provider Name (Legal Business Name): BRYAN RUCHIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SIGMAN RD NE STE 220
CONYERS GA
30012-3819
US

IV. Provider business mailing address

2400 WISTERIA DR SUITE A
SNELLVILLE GA
30078-2689
US

V. Phone/Fax

Practice location:
  • Phone: 678-210-0311
  • Fax: 678-210-0335
Mailing address:
  • Phone: 770-982-0102
  • Fax: 770-982-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008443
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: