Healthcare Provider Details

I. General information

NPI: 1104354943
Provider Name (Legal Business Name): RYAN EDWARD TESCH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 RIDGELAKE DR STE 209
METAIRIE LA
70002-4934
US

IV. Provider business mailing address

2901 RIDGELAKE DR STE 209
METAIRIE LA
70002-4934
US

V. Phone/Fax

Practice location:
  • Phone: 504-309-0868
  • Fax: 504-309-0867
Mailing address:
  • Phone: 504-309-0868
  • Fax: 504-309-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03781
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: