Healthcare Provider Details

I. General information

NPI: 1568906501
Provider Name (Legal Business Name): DAPHNE RYAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-3074
US

IV. Provider business mailing address

250 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-3074
US

V. Phone/Fax

Practice location:
  • Phone: 757-596-1900
  • Fax: 866-420-0168
Mailing address:
  • Phone: 757-596-1900
  • Fax: 866-420-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT00009824
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP046970T
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0008409
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: