Healthcare Provider Details

I. General information

NPI: 1851936470
Provider Name (Legal Business Name): RYAN GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 ROLLING GLEN DR
SPRING TX
77373-3181
US

IV. Provider business mailing address

2619 ROLLING GLEN DR
SPRING TX
77373-3181
US

V. Phone/Fax

Practice location:
  • Phone: 281-704-0978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2146157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: