Healthcare Provider Details

I. General information

NPI: 1164434007
Provider Name (Legal Business Name): RYAN ANTHONY TAUZELL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 DAVIS ST
INDEPENDENCE VA
24348
US

IV. Provider business mailing address

639 W INDEPENDENCE BLVD
MOUNT AIRY NC
27030-3500
US

V. Phone/Fax

Practice location:
  • Phone: 276-773-1845
  • Fax: 276-773-3912
Mailing address:
  • Phone: 336-783-9400
  • Fax: 336-786-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305203605
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: