Healthcare Provider Details

I. General information

NPI: 1972907343
Provider Name (Legal Business Name): RYAN WHOLEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N ARLINGTON AVE
RENO NV
89503-4723
US

IV. Provider business mailing address

555 N ARLINGTON AVE
RENO NV
89503-4723
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-3040
  • Fax: 775-786-1358
Mailing address:
  • Phone: 775-786-3040
  • Fax: 775-786-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3043
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3043
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: