Healthcare Provider Details

I. General information

NPI: 1306171780
Provider Name (Legal Business Name): RYAN T LLANTO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 TAYLOR RD
CHESAPEAKE VA
23321-5536
US

IV. Provider business mailing address

2509 GEORGE MASON DR UNIT 6063
VIRGINIA BEACH VA
23456-1702
US

V. Phone/Fax

Practice location:
  • Phone: 757-484-2532
  • Fax:
Mailing address:
  • Phone: 704-724-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205898
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: