=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417190547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA JEAN RYAN PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2009
-----------------------------------------------------
Last Update Date | 04/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9181 MEDCOM ST
-----------------------------------------------------
City | N CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-9168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-820-7777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 ALEXANDER ST APT B
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29403-6607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-724-1099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2024
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 4061
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------