Healthcare Provider Details

I. General information

NPI: 1881416014
Provider Name (Legal Business Name): DR. ELYSE KATHERYN RYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TERRY DR STE 15
NEWTOWN PA
18940-1837
US

IV. Provider business mailing address

4 TERRY DR STE 15
NEWTOWN PA
18940-1837
US

V. Phone/Fax

Practice location:
  • Phone: 267-685-6368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT030981
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: