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General NPI Number Information
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NPI Number | 1497251656
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Entity Type | Individual
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Provider Name | CHRISTINE NICHOLE RYAN PTA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 9085 TOWN CENTER PKWY
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4240
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Country | US
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Telephone | 941-549-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 27TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34209-6209
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Country | US
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Telephone | 863-303-8885
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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 | PTA24752
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License Number State | FL
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