Healthcare Provider Details

I. General information

NPI: 1952763591
Provider Name (Legal Business Name): RYAN MYERS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VILLAGE BLVD SUITE 4
PLAIN CITY OH
43064-8026
US

IV. Provider business mailing address

500 LONDON AVE
MARYSVILLE OH
43040-5512
US

V. Phone/Fax

Practice location:
  • Phone: 614-504-7145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014849
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: