Healthcare Provider Details

I. General information

NPI: 1508236456
Provider Name (Legal Business Name): DANIEL RYAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BALDWIN ST
FRANKLIN NH
03235-2000
US

IV. Provider business mailing address

30 GREENVIEW DR APT 33
MANCHESTER NH
03102-8911
US

V. Phone/Fax

Practice location:
  • Phone: 603-934-2541
  • Fax:
Mailing address:
  • Phone: 617-548-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1207
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: