Healthcare Provider Details

I. General information

NPI: 1801078456
Provider Name (Legal Business Name): PATRICE RYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MAIN ST
HELLERTOWN PA
18055-1525
US

IV. Provider business mailing address

924 MAIN ST
HELLERTOWN PA
18055-1525
US

V. Phone/Fax

Practice location:
  • Phone: 610-838-7945
  • Fax: 610-838-1464
Mailing address:
  • Phone: 610-838-7945
  • Fax: 610-838-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003030L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICE A RYAN
Title or Position: OWNER
Credential: DPM
Phone: 610-838-7942