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General NPI Number Information
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NPI Number | 1336507789
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Entity Type | Organization
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Legal Business Name | RYAN MONACO PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 2413 STATE ROUTE 5
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City | UTICA
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State | NY
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Zip | 13502-7717
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Country | US
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Telephone | 315-732-0949
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Fax | 315-732-0960
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Provider Business Mailing Address
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Address Line | 31 SHERRILL LN
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City | NEW HARTFORD
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State | NY
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Zip | 13413-2834
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Country | US
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Telephone | 315-732-0949
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Fax | 315-732-0960
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN MIKEL DEBIASE MONACO
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Credential | PT, DPT, ATC
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Telephone | 315-292-4032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 34595
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License Number State | NY
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