Healthcare Provider Details

I. General information

NPI: 1265366231
Provider Name (Legal Business Name): RYAN PATRICK CAMACHO BARRIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19819 32ND RD FL 2
FLUSHING NY
11358-1901
US

IV. Provider business mailing address

19819 32ND RD FL 2
FLUSHING NY
11358-1901
US

V. Phone/Fax

Practice location:
  • Phone: 347-361-9101
  • Fax:
Mailing address:
  • Phone: 347-361-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014200-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: