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General NPI Number Information
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NPI Number | 1457731499
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Entity Type | Organization
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Legal Business Name | THIN RYNO, PLLC
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 5036 GADSDEN AVE
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City | FORT WORTH
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State | TX
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Zip | 76244-5919
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Country | US
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Telephone | 817-253-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 5036 GADSDEN AVE
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City | FORT WORTH
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State | TX
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Zip | 76244-5919
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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 | MAJORITY MEMBER
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Name | MEREDITH COLEY RYAN
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Credential | PA-C
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Telephone | 817-253-7605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5608
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License Number State | AZ
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