Healthcare Provider Details

I. General information

NPI: 1609411487
Provider Name (Legal Business Name): RYAN ROMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY RD
EBENSBURG PA
15931-3516
US

IV. Provider business mailing address

151 HUNTER DR
CRANBERRY TOWNSHIP PA
16066-7605
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax: 814-472-6445
Mailing address:
  • Phone: 724-991-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT028239
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: