Healthcare Provider Details

I. General information

NPI: 1932637881
Provider Name (Legal Business Name): RYAN PATRICK DOLAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 DORCHESTER AVE STE B
CAMBRIDGE MD
21613-2425
US

IV. Provider business mailing address

2272 RICHARDS AVE
ATCO NJ
08004-1260
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-5100
  • Fax: 410-228-7479
Mailing address:
  • Phone: 609-707-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0016005
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT026390
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298005
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23540
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29017
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: