Healthcare Provider Details

I. General information

NPI: 1386108306
Provider Name (Legal Business Name): RYAN JOSEPH KRISTYNIK PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BLOSSOM ST
WEBSTER TX
77598-4210
US

IV. Provider business mailing address

3023 MARINA BAY DR STE 105
LEAGUE CITY TX
77573-2882
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-9537
  • Fax: 833-520-1435
Mailing address:
  • Phone: 281-549-6404
  • Fax: 832-864-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2112990
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: