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General NPI Number Information
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NPI Number | 1134701543
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Entity Type | Individual
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Provider Name | RYAN BACLIT
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Gender | Male
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Dates
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Enumeration Date | 04/25/2021
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Last Update Date | 04/25/2021
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Provider Practice Location Address
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Address Line | 575 8TH AVE FL 6
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City | NEW YORK
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State | NY
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Zip | 10018-3158
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Country | US
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Telephone | 212-221-1544
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Fax |
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Provider Business Mailing Address
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Address Line | 17018 76TH AVE
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City | FRESH MEADOWS
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State | NY
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Zip | 11366-1319
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 012676-01
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License Number State | NY
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